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New MN-ITS Screen 837 Dental Training Handout

1. Situational Adjudication Payment Date Adj Reason Code Adj Reason Code Adj Amount 5 00 90 00 Delete Copy Type of Claim Adj Amount 95 00 Original if applicable complete all fields within a section Paid Unit Count Adj Quantity Adj Quantity Delete Delete Application Progress Billing Provider Edit Subscriber Edit Claim Information Edit w COB Edit 7 Claim Services Related Links MN ITS User Guides Provider Website MHCP Payment Claim Calendars Provider Training MHCP Provider Profile Change Forms o In Pra Organization Provider Enrollment D NDC Search Washington Publishing Company Questions or Comments Contact Us Verify all of the other payers paid amounts and adjustments that display in the COB table for this service line have been entered If all entries have been made select the Save action button directly below the COB table 02 Other Payer Summary Table COB Line Payments Adjustments Dental 837D Services Application Progress amp Print Page wBilling Provider Edit W Subscriber Edit Billing Provider MHCP PROVIDER Total Claim Charge Amount 95 00 Claim Information Edit w COB Edit Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original 7 Claim Services Situational if applicable complete all fields within a section Related Links erG MN ITS User Guide MHCP Payment C
2. Direct questions to the leaders and assistants group Audio Minnesota Health Care Programs Before we begin would like to show you some tips for using the webinars features such as Changing your screen view Using the Chat feature e And suggestions for audio quality Using the Webinar Change Screen Move cursor to the top of screen Tool Bar Displays Select Exit Full Screen mar ooh A Ne OS OST Sharing Daniele bean U Minnesota Health Care Programs If you find that your view has changed to full screen mode these options will restore the webinar display Move your cursor to the top of the screen Atool bar will drop down and display several options Select the Exit Full Screen option Once you have exited the full screen mode you will see the three tiered webinar display with The menu bars on top The chat feature on the left side toward the bottom of the screen And the presentation in the center Using the Webinar Sharing Tab Select Sharing tab to see presentation if screen is blank Minnesota Health Care Programs If you get stuck on a blank screen or end up back on the start page make sure you select the sharing tab in the top center of the display to return to the presentation Using the Webinar Chat To chat select the private tab Select leaders and assistants group Type your question comment Select
3. Washington Publishing Company Questions or Comments Contact Us 2011 Minnesota Department of Human Services Online Updated 11 19 2012 10 43 19 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology From the right navigation menu the next link accesses the Fee Schedule for MHCP Fee for service recipients ths Minnesota Department Fee Schedule of Human Services DHSHome Page Forms eDocs Countyand Tribal Workers AzTopics About DHS Aging Partners amp Providers Children Disabilities Economic Supports _ gt Partners and Providers gt MHCP enrolled providers gt Billing resources gt Fee schedule MHCP enrolled provider MHCP provider toolbox Billing resources Fee schedule Calendars amp Reading the PCN Electronic Claim Attachments NCCI FAQs Much of the provider information contained on this MHCP Provider Web page is copyrighted by the American Medical Association AMA and the American Dental Association ADA This includes items such as CPT and CDT codes Before you can enter this MHCP Provider Web page please read and accept an agreement to abide by the copyright rules about the information you find within this page If you choose not to accept the agreernent you will return to the previous page POINT AND CLICK LICENSE FOR USE OF CURRENT DENTAL TERMINOLOGY CDT End User License Agreement
4. 9 Print Page V Billing Provider Subscriber If the Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Claim Information COB Billing Provider Information Claim Senicee Organization MHCP PROVIDER Taxonomy Related Links MNS Address 1234 MAIN STREET MN ITS User Guides Address2 Provider Website City ANYTOWN State MN Zip 55155 Electronic Claim Attachments MHCP Payment Claim Telephone 651 431 2700 EH zb ment Claim hedul Provider Training MHCP Provider Profile Change Forms Cancel o Individual Practitioner Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Coni 2011 Minnesota Department of Human Services Online Updated 11 19 2012 10 43 19 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology Select Continue to move to the Subscriber screen Subscriber Dental 837D Subscriber Application Progress MBilling Provider Edit Subscriber Claim Information OB Billing Provider MHCP PROVDER Claim Services Required Field Subscriber Related Links MNHTS User Guides Subscriber ID Birth Date Search Provider Website Electronic Claim Attachmentg Continue MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms o
5. The Delete action button will completely remove all entries that were made for line one In our example we will select ADD to create a new blank line 100 Services Screen Required Fields Line 2 Completed Dental 837D Services Billing Provider MHCP PROVIDER Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Required Field Line 2 Date of Service 08 01 2013 From Place of Senice 11 OFFICE Procedure Code Diagnosis V72 2 w select one select one Pointer s Line Item Charge Amount Other Payer amp Print Page Total Claim Charge Amount 95 00 Type of Claim Original Situational if applicable complete all fields within a section Procedure Code Modifiers 1st Modifier 2nd Modifier 3rd Modifier 4th Modifier select one Procedure Count es Situational Services Other Providers Save View Line s Cancel Copy Delete For line two we have entered the following required fields Date of service Place of service Procedure code Diagnosis Pointer Anda Procedure Count Application Progress Billing Provider Edit w Subscriber Edit W Claim Information Edit w COB Edit 7 Claim Services Related Links MN ITS User Guides Provider Web MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms y ington Publishing Company Questions or Comments Contact
6. First Middle Property and Casualty Claim Attachment Send Date A Biller 651 123 4567 Contact Name Phone Total Number of Pages 2 Complete the document matching the attachment control number billing provider ID number and name as well as the recipients name that matches your claim Indicate the total number of pages and a contact name and phone number Fax the AUC cover sheet along with all supporting documentation to the fax number selected for MHCP Situational Claim Information Accident Information Dental 837D Claim Information er MHCP PROVIDER 01044759 FIFTYTEN M TESRECIPO2 The next subsection is Accident Information If the service is related to an accident use the appropriate related causes indicator AA Auto accident EM Employment related accident OA Other Accident Also include the Date of Accident in the following format DD MM YYY Y Other Providers Claim Level Dental 337D Claim Information Application Progress F s Mailing Provider Subscriber BilingProvider MHCP PROVDER F Claim information cos Original Claim Services Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Required Field Related Links or Authorization Nu Claim ex MHCP Provider Profile Change Forms Attach Control Nu j Continue Now we will select the Other Providers Claim Level accordion panel Other Providers Claim Level
7. MHCP Provider Profile Change Forms o Individual Practitioner o Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments e Contact If the subscriber ID and birthdate you enter does not match information on file for a MHCP recipient you will receive a message stating Subscriber not found 48 Subscriber New Entry Dental 837D Subscriber Application Progress 9 Print Page mBilling Provider Edit v Subscriber J Claim Information E3 Subscriber ID must be entered COB Date of Birth must be entered Claim Services Related Links MHCP PROVIDER Billing Provider MN ITS User Guides Required fields Provider Websit Subscriber lectroni laim Af hment Subscriber ID 01044759 Birth Date 01 01 1993 MHCP Payment Claim Calendars E hedul Back Cancel Continue Provider Training MHCP Provider Profile Change Forms o Individual Practitioner Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Contact Us 2011 Minnesota Department of Human Services Online Updated 11 19 2012 13 37 06 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology Once you have correctly completed the subscriber ID and their birthdate select the Search action button 49 Subscriber Information Dental 837D
8. MMSI 855 619 0010 MN Dept of Human Services 651 431 7786 Noridian Medicare Part A NJA Le ler ID amp OptumHealth Behavioral 248 733 6085 j OptumHealth Complex Med OptumHealth Physical Health 763 595 3333 Name PreferredOne 763 847 4010 j PrimeWest Health 320 335 5292 Sanford Health Plan 605 328 6840 int ID UCare Minnesota 612 884 2261 UnitedHealthcare Medical 801 994 1076 Patient Name First Middle Select fax to display a drop down list of fax numbers for the payers and select MN Dept of Human Services 651 431 7786 MHCP only accepts claims attachments at this fax number Administrative Uniform COVER SHEET Uniformity For Health Care Claim Attachments NOTE To maximize use of this form use of Microsoft Word Committee version 2003 or later is recommended Select appropriate payer group purchaser from the drop down listor fill in the Other option TO Select fax MN Dept of Human Services 651 431 7786 2 Other fax Type payer group purchaser name and fax if not in drop down list Name MHCP Fax 651 431 7786 Tab or use your arrow keys to navigate to the next or previous text field For specific field directions refer to the In i Attachment Control Number 18ATK Billing Provider ID 1234567890 Billing Provider Name MHCP PROVIDER Patient ID 03906179 Patient Name TESTRECIPO2 FIFTYTEN M Last
9. Other Payer Amounts Payer Paid Amount Other Insurance Information Benefits Assignment No NotApplicable Release of Information Informed Consent Insurec ID Total Claim Charge Amount Type of Claim Other Payer PrimarylD DOOOOOOX Adj Amount Adj Reason code Non Covered Charge Amount Original Relationshir Code 18 Self Adj Quantity Add AdjAmount Adj Quantity 1 Ctaim Services Provider website uationat if applicable complete all fields within a section Elec cc Attache MHCP PaymentCiaim Calendars Fee Sched rovider Trainin MHCP Provider Profile Change Forms Individual Prac 2 Provider Enrollment NDC Search Washington Publishing Company Questions or Comments ContactUs Continue Displayed at the top of the screen you will now see a message informing you the Claim Level COB has been saved Additional COB Entries Dentai 837D COB DOOOOOO X An additional action button ADD will now appear If there is another insurance payer responsible prior to MHCP coverage you must select the ADD action button at the COB Claim level section Enter the other payer information following the same steps as the first entry and indicate the payer responsibility as secondary Providers who wish to remove their claim level COB entry can do so by selecting the Delete action button 82 COB Continue Dental 837D COB Claim Level COB has bee
10. Subscriber Application Progress Print Page lan Billing Provider Edit E Subscriber Claim Information B MHCP PROVIDER f Billing Provider E Claim Senices Required fields Subscriber Related Links Subscriber ID 01044759 Birth Date 01 01 1993 Mim Electronic Claim Attachments First Name FIFTYTEN Middle Initial R Last Name TESTRECIPO2 MHCP P i MHCP Payment Claim Calendars Gender F Fee Schedule Provider Training MHCP Provider Profile z Change Forms Continue o Individual Practitioner Organization Provider Enrollment NI ch Washington Publishing Company Questions or Comments Contact Us 2011 Minnesota Department of Human Services Online Updated 11 19 2012 13 50 12 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology When a match is found additional subscriber information is displayed in a table that has protected fields that cannot be modified Finding a match does not guarantee the recipient is eligible for the service your are providing Providers are required to verify eligibility prior to preforming the service Using the MN ITS Eligibility Request is the best way for you to make sure they are currently eligible on a fee for service major program that covers the dental service you are providing 50 Subscriber Continue Dental 837D Subscriber Billing Pro
11. 837 Dental 837D Skip to Main content Subnavigation Quicklinks thei Minnesota Department of Human Services ties Home ABiller 1234567890 Logout Mailbox MNATS Submit Interactive Claims 837 Related Pages Eligibility Request 270 Validate before you submit your claim to make sure you Auth n Request 278 I i i Troubleshooting Guide Submi insactions Submit DOE Claims 837 Comohiad all Tide MHCP Payment amp Claim Professional 927P Can make corrections Cut off Calendars Can avoid denied claims MHCP Fee Schedul Institut 71 Request Claim Status 276 XI2INCPDP Submitters Provit User Administration P User Guides Provider Websi CCDS Reporting System Sign Up for Email Lists n Related Links Last Check MFPP Forms Ombudsman Dats Washington Publishing Pay for Performance Company Provider Lists Individus PCAs NOC Search Provider Lists RxPrice Compare Update Taxonomy Contract Code Maintenance Questions or Comments Contact Provider Relations From the left navigation under Submit DDE Claims select Dental 837D to go to the new dental claim screens Dental 837D Billing Provider Dental 837D Billing Provider Print Page amp If the Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Billing Provider Information Organization MHCP PROVIDER Taxonomy Address 12
12. Contact Us 2011 Minnesota Department of Human Services Online Updated 11 19 2012 10 43 19 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology Next on the right navigation menu the Provider Training page brings you to a list of our available trainings aetas anno MHCP provider toolbox Billing resources Communication News Updates E mail lists gt Training Enrollment Industry Initiatives Manual Prescription drug information adolescent services Chil Idren s mental health Disability services Employment services manual Food support outreach Grants and RFPs IEP providers Managed care organizations 1 State LTC profile HCBS partners panel Provider Training Skip to Main content S ubnavigation Quicklink POU ECE keyword st Search Partners amp Providers children Dssbites Economic supports Hoarn care Publestons enam gt Partners and Providers gt MHCP enrolled providers gt Communication gt Training Provider Training Home The DHS Provider Relations unit coordinates training for fee for service providers enrolled to serve recipients of Minnesota Health Care Programs This page is updated regularly to reflect upcoming provider workshops Available Training Sessions registration required Webinar MN ITS Dirt ntry ODE New Screen and Functionality Chan Training for PCA Prov
13. Providers must repeat this process until each oral cavity designation code has been added Again MHCP will process all codes reported as one service line Tooth numbers or oral cavity designations should not be reported on claims for partials or dentures Situational Services Prosthesis Information Dental 837D Services Application Progress Billing Provider Edit Sul t Billing Provider MHCP PROVIDER Total Claim Charge Amount 95 00 Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original Situational if applicable complete all fields within a section The remaining sub section allows provider to enter the Prosthetic code that indicates if the appliance is an Initial or replacement prosthesis and the prior placement date Date of the orthodontic banding Orthodontic appliance replacement date Other Provi IDental 837D Services Billing Provider MHCP PROVIDER Subscriber 01044759 FIFTYTEN R TESTRECIPO2 equired Field Line 1 Other Payer Situational Service Prior Authorization Number Fixed Form Information Tooth Information Tooth Code Select One Tooth Surface Select One Oral Cavity Designation Select One M Prosthesis Information Prosthesis Code Select One Orthodontic Banding Date or Prov Save View Line s Cancel ers Accordion Panel Application Progress amp Print Page IBilling Provider Edit Subscriber Edit w Claim Information Ed
14. Related Pages e MN ITS e MHCP Provider Directory e NOC Search e PERM e Cultural Competency chan Reine Links Spoken Language Health Reading your RA Communication Enrollment Industry Initiatives Manual Prescription drug information These materials contain Current Dental Terminology CDT copyright 2008 2010 American Care interpreter Roster Dental Association ADA All rights reserved CDT is a trademark of the ADA e State Statutes Laws amp THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUI Rules ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT BY Washington Publishin CLICKING BELOW ON THE BUTTON LABI ER ACKNOWLEDGE THAT YOU HAVE READ UNDERST T000 AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEEM IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN jTAccePer IDONOTACCEPT T ReportRate this page A Point and Click End User License Agreement will display Once you have accepted the Point an Click License you can use the fee schedule to locate the CDT code and verify the MHCP total allowed amount for a service Providers should submit their usual and customary charge for the services they render This way MHCP will have a current value for the service to compare when reviewing rates Remember legislative cutbacks and or add ons are not included in the total allowed amount that is displayed The 396 payment rate reduction for dental
15. Rendering Provider Dental 837D Claim Information Billing Provider MHCP PROVDER Subscriber 01044759 FIFTYTEN R TESTRECIP02 Required Field Claim Information Situational Claim Information Other Providers Claim Level Provider Identifier NPI UMPI 8888888887 Add Name Address No records found Pay To Provider Referring Provider Service Facility Location Assistant Surgeon Provider Cancel Total Claim Charge Amount Type of Claim Original 9 Print Page situational if applicable complete all fields within a section Taxonomy Information Continue Application Progress WBilling Provider Edit W Subscriber Edit 7 Claim Information COB Claim Services Related Links M Jser Guides Provider Website Electronic Claim Attachments MHCP Payment Claim Calendars Fee Schedule MHCP Provider Profile Change Forms Individual Practitioner o Organization Provider Enrollment NDC Search Company Questions or Comments Contact Us The other providers claim level opens to the rendering provider subsection Enter the NPI or UMPI for the Rendering provider and select the Add button to save your entry 73 Other Providers Claim Level Other Provider Types Dental 837D Claim Information Application Progress amp PrintPage Ain SOS MBilling Provider Edit W Subscriber Edit Claim Informati Billing Provider MHCP PROVIDER Total Claim Charge A
16. Type of Claim Original Situationat if applicable complete all fields within a section Application Progress Billing Provider Edit Subscriber Edit Claim Information Edit v COB Claim Services Related Links MNATS User Guides Provider Website Electronic Claim Attachments Other Other MHCP PaymentClaim Calendars Payer Health Insurance Co Payer 493456 Primary Name ID Fee Schedule Claim Provider Training Filing v Indicator Select One MHCP Provider Profile Change Forms c Individual Practitioner c Organization ProviderEnrollment NDC Search Continue Back Cancel Washington Publishing Company Questions or Comments ContactUs Use the Coordination of Benefits COB screen to report other payer information also referred to as other insurance or TPL If you do not need to report other insurance select the continue action button to move to the claim services screen Providers are not required to bill MHCP if the other payer s paid amount is more than our MHCP allowable Billers should check with the providers business office on their policy in case there is a business need to submit the claims to properly reconcile your accounts The new MN ITS screens allow providers to submit COB payment and adjustment information at the line level for line by line adjudication In our example today we will be showing you what COB fields need to be completed at the claim
17. Washington Publishing mpany Situational Claim Information pene Questions or Comments r Providers C avel Other Providers Claim Level ContactUs The assignment plan participation benefits assignment release of information and provider indicator fields are automatically default with the standard responses assigned yes and signature on file If the default response is incorrect select the radio button for the response that best describes the actual documentation the provider has on file 56 Claim Information Screen Dental 837D Claim Information Billing Provider MHCP PROVIDER Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Required Field ati Claim FrequencyCode Original O Replacement O Place of Service 1 1 OFFICE Patient Control Number AssignmentPlan Participation Benefits Assignment Release of Information Provider Indicator nter Diagnosi Diagnosis Code Sequence Situational Claim Information Other Providers Claim Level Back Cancel Total Claim Charge Amount Type ofClaim Original Situationat if applicable complete all fields within a section Void Payer Claim Control Number Y Assigned NotAssigned gt Yes O No NotApplicable Yes O Informed Consent Signature onFile Signature noton File Diagnosis Code Delete Continue Application Progress WBilling Provider Edit 8i Subscriber Edit 7 Claim Information CoB Cla
18. vider specia ion code has been added to the roi ide fie If multiple taxonomy codes have been added additional information will display Select the radio button to identify appropriate location for this claim Address 1 28 The first address line reported on the provider file Loop 2010AA N301 alphanumeric The Billing Provider help information is displayed in a separate pop up window as a table format The first column is the field name which identifies the name of the field and the electronic X12 loop and element associated to the field The next column Valid Values provides the X12 format used in the field Next is Character Length lists the maximum number of allowed characters that may be entered The last column is Field Description provides a description of what the fields purpose For additional instruction on completing fields for a specific service refer to the MN ITS User Guides link at the top Select the X in the right hand corner to close the help screen Application Progress Dental 837D Billing Provider 9 Print Page Z If the Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Billing Provider Information Organization MHCP PROVIDER Taxonomy Address 1234 MAIN STREET Address2 City ANYTOWN State MN Zip 55155 Telephone 651 431 2700 2011 Minnesota Department of Human Services Online North Star is led by the Office of Enterpri
19. 11 OFFICE Fee Schedule Procedure Code Modifiers 1st 2nd 3rd 4th Modifier Modifier Modifier Modifier MHCP Provider Profile Change Forms Provider Training Procedure Code Diagnosis A V72 2 w select one v select one select one v o Individual Pointer s Practi er o Organization Line Item Charge Procedure Count Amount Provider Enrollment NDC Search Other Payer Washington Publishing Situational Services Company Other Providers Questions or Comments Contact Us Delete Cancel Providers must re save their line each time they view or make corrections to the service line to assure the information will be retained on the claim Select Save View Line s Services Validate Dental 837D Services Application Progress Print Page Billing Provider Edit Ww Subscriber Edit Billing Provider MHCP PROVIDER Total Claim Charge Amount 115 00 Claim Information Edit COB Edit Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original 7 Claim Services Required Field Situational if applicable complete all fields within a section Related Links F MN ITS User Guides Line From Charges POS o Provider W 1 08 01 2013 D 95 00 1 Edit Brain i ebans Electronic Claim 2 08 01 2013 20 00 11 Edit Attachments MHCP Payment Claim Calendars Fee Schedule Provider Training Back Cancel Submit Validate MHCP Provider Profile Change Forms K o Ind
20. Batch responses o MN ITS application MHCP continues to add messages to the 5010 D 0 page as information is known and will place a link to the page in your MN ITS mailbox LINKS folder when adding new information Sign up to get e mai notices of Provider Updates News and changes to your Manual sections Wednesday October 24 2012 north Stan Scheduled Downtimes Sundays 6 00 a m thru noon 8 00 p m thru Monday 1 00 am Mondays Non warrant Wednesdays e X12 8375 received but not processed Mondays between 5 00 a m and 2 00 p m 10 00 to 10 15 AM Warrant Saturdays o 6 00 to 7 30 PM Sunday September 16 6 00 AM 12 00 Noon Related Pages Related Links Washington Publishing Company NDC Search Questions or Comments First providers will log in to MN ITS as they currently do entering they individual username and password MN ITS Transactions Skip to Main content Subnavigation Quicklinks the Minnesota Department of Human Services CNN ITS Home north Star ABillerQ 1234567890 Logout Mailbox Transaction Responses pllaneous Received User Administration User Guides Last Check Provider Lists Individual PCAs Provider Lists Mailbox Home Visit the Provider Updates link under Related Pages in the right column to keep up to date Your access to MN ITS functions and applications on the left menu under MN ITS has been tailored based on
21. Claim Original Situational if applicable complete all fields within a section Paid Amount Total Adj Amt 0 00 95 00 Copy Delete Select the Situational Services accordion panel Application Progress SBilling Provider Edit wi Subscriber Edit i Claim Information Edit COB Edit 7 Claim Services Related Links MN ITS User Guides Provider Website Electronic Claim Attachments MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms o Individual Practitioner Organization Provider Enrollment NI rch Washington Publishing Company Questions or Comments Contact Us Situat Fixed Dental 837D Services MHCP PROVIDER 01044759 FIFTYTEN R TESTRECIPO2 Billing Provider Subscriber Required Field 1 Services Other Payer Prior Authorization Number ional Services orm Information amp Print e Total Claim Charge Amount 95 00 Type of Claim Original complete all fields within a section 2Situational if applicable Fixed Form Information Tooth Information Tooth Code Select One Tooth Surface Select One Oral Cavity Designation Select One Prosthesis Information Prosthesis Code Select One Orthodontic Banding Date Other Provide Save View Cancel Line s Code Tooth Surface No records found Code No records found Prior Placement Date R
22. Search Questions or Comments o Contact Provider Relations Accessibilty Terms Policy Contact DHS Top of Page Now we are going to take a look at the new layout and functionality of the Request Claim Status transaction From the MN ITS Home page left navigation menu select Request Claim Status 276 132 Claim Request Status 276 Skip to Main content Subnavigation Quicklinks CHN ITS Home 4 amp t Minnesota Department of Human Services north Star Abiller 1234567890 Logout Health Care Claim Status Request Related Links MNHTS User Guides Provider Website zRequired Field Quick Search Subscriber ID Service Date From Serice Date To MHCP Payment Claim I Pay To Provider Calendars NPI UMPI Fee Schedule Electronic Claim Attachments Detail Search Provider Training MHCP Provider Profile Payer Claim Control Number Change Forms Pharmacy Prescription Number Individual Practitioner Organization Submit Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Contact Us This is the new layout of the Request Status transaction Changes were made to follow the new 5010 electronic billing requirements New is the Pay To Provider NPI UMPI field where billing agencies clearinghouses and other billing organizations who submit claims on a providers behalf will now be able to retrieve those claims they submi
23. Us Next we will select the Other Payer s Accordion Panel to add the COB information for line 2 Other Payer Line Level Paid Amount amp Adjustment Dental 837D Services lApplication Progress amp Print Page Billing Provider Total Claim Charge Amount 95 00 Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original Situational if applicable complete all fields within a section Related Lir MNHTS Us ei 123456 Health Insurance Co fier Adjudication Payment Date COB Line Adjustments Entry Claim Adjustment Group Code Adj Reason Code CO Contractual Obligations 45 up Code Adj Reason Code No recor Again refer to the other payer s explanation of benefits or EOB you will need to enter the Claim Adjustment Reason Codes and the associated Adjustment amounts If their EOB does not include HIPPA compliant reason codes refer to the Washington Publishing Companies Website Reference tab to review the list of codes available In the service line paid amount enter the amount that the other payer paid on this individual line they paid 10 00 Paid unit count should always be 1 Next in the COB line adjustments entry fields we selected CO contractual obligation from the drop down list the corresponding reason code 45 and the amount of the provider write off 2 00 Select Add to save the entry Other Payer Line Level Paid Amount amp Adjustment Cont IDental 83
24. attachments are complex claims for prompt payment purposes Enrollment Do not send paper claims with attachments Industry Initiatives Manual Prescription drug information Review the M Adolescent services Complete the AUC Co aims required for all attachments across MN Do not Luis use the AUC Appeals Cover Sheet Use the AUC Uniform Cover Sheet only for electronic claims that require Aging services an attachment Do not use the AUC Uniform Cover Sheet without an attachment control number ACN or to submit authorization requests that require attachments Alcohol andidrug Mua Create a unique ACN ACN must be unique to each claim and not patient account number Child and Teen Checkups unless patient has new account number each visit Child care providers Enter the appropriate ACN including spaces hyphens on each attachment page each type cl support of attachment must have its own completed Cover Sheet the Cover Sheet and your Children s menter SR electronic claim Interactive Enter the ACN s in the Claim Information tab Attachment Control County redesign Number PWK field select the qualifier in the type field Disability services Batch Enter the ACN s in Loop 2300 PWKO6 enter the attachment type in Loop Employment services 2300 PWKO1 enter the method by which you send the attachment information in Loop manual 2300 PWK02 follow complete AUC Attachment Cover Sheet Instructions Food support outreach 3 Submit the claim ele
25. enter to send Minnesota Health Care Programs As mentioned earlier questions will be answered at the end of each section during the presentation However if you are experiencing technical issues or you wish to submit a question please use The chat feature that is located in the lower left of your webinar display Select the private tab Select Leaders and Assistants group Type in your question or comment Select enter to send we will respond to your technical issues as quickly as possible Audio Some suggest headsets for better sound quality f sound issues s Exit the Webinar a Re select the link in the Webinar s reminder email Minnesota Health Care Programs Some people suggest headsets provide better sound quality However you may listen to the webinar through your computer speakers as well If you experience sound issues Exit the webinar by closing the window Log back in to the webinar using the link in the reminder email that was sent to you New MN ITS Screens Layout and Functionality Minnesota Health Care Programs Now we will begin our presentation of the new MN ITS screen changes their layout and navigation functionality Log in to MN ITS Skip to Main content Subnavigation Quicklinks thei Minnesota Department of Human Services Login Here You must be MHCP enrolled and MN ITS registered and agree to these terms and conditions Username AB
26. instruction to Use the MN ITS Mailbox Verify recipient Eligibility Submit authorization requests Submit fee for service FFS claims Copy replace and void claims Use other applications Return to MN ITS Report Rate this page 2012 Minnesota Department of Human Services Online Updated 10 22 12 1 38 PM Accessibility Terms Policy Contact DHS Top of North Star is led by the Office of Enterprise Technology Page First from the left side navigation menu select Table of Contents MN ITS User Manual Skip to Main content Subnavigation the Minnesota Department of Human Services MN TTS User Manual gt MN ITS User Manual gt Table of Contents Advanced Search Table of Contents MN ITS User Manual Table of Contents Direct Data Requests Table of Contents Submit DDE Claims These user guides include step by step instructions to help providers use all functions and features of MN ITS Direct Data Entry ODE MN ITS Administration MN ITS Account Registration Log in to MN ITS and change your password Access and use MN ITS Mailbox Create Modify MN ITS User Access Change Primary Administrator Direct Data Requests Eligibility Verification 270 271 Authorization Requests 278 CT and MRI Imaging Services DBT Intensive Outpatient Program IOP Dental Dental with Consolidated NPI DME Hearing Aids Prosthetics and Orthotics Home care Medical services Medical a
27. services ended on June 30 2013 It s important to note that the fee schedule does not indicate if a procedure is not covered for the Non pregnant adult population Providers must review the MHCP Provider Manuals Dental Non pregnant adult section for a list of eligible procedure codes Codes that are not listed in the manuals Non pregnant adult covered services section means they are a non covered service Providers must inform the recipient that a service is non covered prior to preforming that service using the Advance Recipient Notice of Non covered Service Item form number DHS 3640 which was mandated as of July 2012 3l Provider Training Dental 837D Billing Provider Application Progress Print Page 7 Billing Provider Subscriber amp If the Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Claim Information COB Billing Provider Information Clan Sercoe Organization MHCP PROVIDER Taxonomy Related Links MN IT Address 1234 MAIN STREET S User Guides Provider Website Address2 C City ANYTOWN State MN Zip 55155 s Electronic Clam Attachment MHCP Payment Claim Telephone 651 431 2700 Calendars Fee Schedule Provider Trainin MHCP Provider Profile Change Forms Cancel Continue o Individual Practitioner O Organization Provider Enrollmen NDC Search Washington Publishing Company Questions or Comments
28. ws Adj Amount Adj Reason code Non Covered Charge Amount Notapplicabie Informed Consent Relationship Code Adj Quantity AdjAmount Original complete 18 Self Add Adj Quantity as within a section Application Progress POOLE Aas ping Provider Edit Wi Subscriber Edit m Claim Information Edit 7 COB Claim Services Related Links MNATS L side Provider Website Electronic Claim Attachmen IHCP Payment Claim Provider Training MHCP Provider Profile Change Forms Individual Practitioner Organization Provider Enrollment NOC Search ashinaton Publ Company ning Questions or Comments E actu Continue Next you must save your COB entry before continuing If the entered COB information is not saved it may not apply to your claim properly Select Save Confirmation of Saved Application Progress amp PrintPage Claim Level COE has been saved WBilling Provider Edit Im Subscriber Edit amp i Claim Information Edi ivi cos Billing Provider MHCP PROVIDER Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Required Field 1 P Primary 123456 Health Insurance Co Other Payer Other Payer Health Insurance Co Name Claim Fil C Commercial Insurance Indicator Other Payer Subscriber P Primary Claim Level Adjustments Adj Reason Code Claim Adjustment Group Code Select One Claim Adjustment Group Code No records found
29. 12 Pay To Provider NPI UMPI Detail Search Payer Claim Control Number Pharmacy Prescription Number After the information has been entered select Submit Senice Date To north Star Related Links MNHTS User Guides Provider Website laim hmen MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms Individual Practitioner o rgant Provider Enrollment NDC Search hin Publishin Company Questions or Comments Search Results laim Status This claim was previously submitted for processing Minnesota Department of Human Services 41 1674742 MHCP Provider Call Center 651 432 2700 14800 366 5411 11 28 2012 09 56 912 40 Patient 01044759 Service Pe Receiver NPVUMPL 1234567890 Name MHCP PROVIDER Provider NPVUMPL 1234567890 Name MHCP PROVIDER Subscriber ID Number 01044759 Name FIFTYTEN TESTRECIPO2 Patient Control Number 3 Claim Information Bill Type D 11 28 2012 11500 Service Period 11 01 2012 Status Info Effective Date 11 01 2012 Payer Claim Control Number Pharmacy Prescription Number Total Claim Charge Amount Claim Payment Amount Adjudication Date Remittance Date Trace Number 0 00 11 28 2012 Claim Status Category F1 3 000000000 277 Related Links MNITS User Guides Provider Website Electronic Claim Attachments MHCP PaymentClaim Calendars Fe
30. 34 MAIN STREET Address2 City ANYTOWN State MN Zip 55155 Telephone 651 431 2700 Application Progress V Billing Provider criber Claim Information COB Claim Services Related Links MN ITS User Guides Provider Website Electronic Claim Attachments MHCP Payment Claim lendars Washington Publishing Company Questions or Comments Contact Us 2011 Minnesota Department of Human Services Online Updated 11 19 2012 10 43 19 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology This brings us to the 837D Billing Provider screen which is now the first of the new screens we will see The billing provider information will auto populate with information from the MHCP provider record on file for the NPI that is used to login to MN ITS Providers can no longer change the billing provider information If you need to identify a different pay to provider you will be able to do that on the claim information screen in the other providers section All other provider types such as rendering referring service facility location or an assistant surgeon can be identified on the claim information screen in the other providers section or on the Services screen in the other providers section Billing Provider Consolidated NPI Dental 837D Billing Provider 69 PrintPage Ifthe Billing Providerinformation is inaccurate complete the appropriate p
31. 4759 FIFTYTEN M TESRECIPO2 08 01 2013 11 OFFICE D0140 The following required fields are now entered on the Services screen for line one Date of service Place of service Procedure code Diagnosis Pointer and Procedure Count Remember the Procedure Count for all CDT dental codes is one For FQHC RHC or IHS Providers billing for a Fee for service recipient enrolled major program BB who is receiving services for a partial denture or full denture bill using the following instructions For services prior to the delivery of the prosthesis bill using D5899 as the procedure code Claims staff will refer to your claim note that was entered on the claims situational services screen For the actual delivery of the prosthesis bill using the appropriate partial or full denture code Services Other Payer IDental 837D Services Application Progress Billing Provider MHCP PROVIDER 01044759 FIFTYTEN M TESRECIPO2 08 01 2013 11 OF FICE D0140 select one M select one Dependent on the services your are submitting you may need to complete one or more of the other service level accordion sections before saving your line level entry If your claim does not include other insurance you can skip the Other Payer accordion section Our example includes other insurance so we will select the Other Payer accordion panel to open the next section COB TPL Line Level Other Payer Primary Identifier Related Links
32. 7D Services Application Progress amp Print Page 9 wing Provider Edit Subscriber Edit Billing Mrice Total Claim Charge w Claim Information Edit Provider Mice PROVIDER Amount 26 00 w COB Edit 7 Claim Services Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original Related Links Required Field Situational if applicable complete all fields within a section MN ITS User Guides Line2 Services Electronic Claim Attachments Other Payer P Payment Claim ndars Other Payer Primary Identifier Service Line 49 00 Adjudication Paid unit Provider Training Paid Amount Payment Date Count MHCP Provider Profile Change Fon COB Line Adjustments Entry Claim Adjustment Group Code Adj Reason Code Adj Amount Adj Quantity 2 Wnawiduat Practitioner PR PatientResponsiblity i 8 00 s S Sraanation Provider Enrollment Claim Adjustment Group Code Adj Reason Code Adj Amount Adj Quantity n N arch co 5 2 00 2 Washington Publishinc Company Questions or Comments Contact Us Situational Services Other Providers Save View Line s Copy Delete ADD Cancel The first entry for line two displays in a table Next from the COB line adjustments entry drop down we select PR Patients Responsibility and enter adjustment reason code 1 deductible and adjustment amount 8 00 Select Add to save the entry Other Payer Line 2 COB Line Adjudication Entry Dental 837D Ser
33. E FAC MENTAL HEALTH 55 RESID SUBSTANCE ABUSE TRMT FAC 56 PYSCHIATRIC RESID TRMT CENTER EEUU S7 NON RES SUBSTANCE ABUSE FAC f GS 60 MASS IMMUNIZATION CENTER Washington Publishing Company Some features remain the same such as the place of service field drop down menus that allow you to select from a list of valid values Radio Buttons Auto Populated Dental 837D Claim Information Application Progress amp PrintPage MBilling Provider Edit Subscriber Edit 7 Billing Provider MHCP PROVIDER Total Claim Charge Amount DUI Ue Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original EIE Related Links MNHTS User Guides Required Field Situationat if applicable complete all fields within a section m Informatio Provider Website Claim FrequencyCode Original O Replacement O Void Payer Claim Control Number Electronic Claim Attachme Place ofService 1 1 OFFICE v MHCP Payment Claim Calendars Patient Control Number Assignment Plan Participation Assigned NotAssigned gt 2 b Provider Training Benefits Assignment Q Yes O No O NotApplicable i P MHCP Provider Profile Release of Information Yes Informed Consent Change Forms Provider Indicator Signature onFile Signature noton File o Individual Enter Diagnosis Code Practitioner Organization Diagnosis Code ganization Provider Enrollment Sequence Diagnosis Code NDC Search 1
34. HCP Attachment Criteria for submitting claims with attachments The required AUC Uniform Cover Sheet for Health Care Claim Attachments which includes the MN Dept of Human Services Fax number 651 431 7786 And instructions on how to complete and submit the Attachment Remember that your electronic claim and the AUC cover sheet must both have the same identifiers in order for MCHP to accurately process your claim If the billing providers NPI Attachment Claim Number or the recipients Subscriber ID are missing or different no match will be found and your claim will deny 27 MHCP Payment Claim Calendars Dental 837D Billing Provider Application Progress amp Print Page VI Billing Provider ze Subscriber amp If the Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Claim Information COB Billing Provider Information Claim Senicee Organization MHCP PROVIDER Taxonomy Related Links MNHT e Address1 1234 MAIN STREET AN ITS User Guides Address2 Provider Website City ANYTOWN State MN Zip 55155 Electronic Claim Attachments z 7 Telephone 651 431 2700 m Payment Claim Fee Schedule Provider Training MHCP Provider Profile Change Forms Cancel Continue o Individual Practitioner Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Contact Us 2011 Minnesota Department of Hum
35. However if you are a FQHC RHC or IHS Provider that is billing a non specified dental code for a Fee for service recipient who is enrolled in MinnesotaCare major program BB and s receiving services for a partial denture or full denture You must enter the specific description that is listed in our MHCP Provider Manual Clinics sections into the Claim Note Entry Field or your claim will deny For services prior to the delivery of the prosthesis enter the claim note as follows Encounter in preparation of a denture or Encounter in preparation of a partial For service after the delivery of the prosthesis enter the claim note as follows Encounter for denture adjustment or Encounter for partial denture adjustment After you have entered your claim note select the Add action button to save the entry Situational Claim Information Claim Note Added amp Print Page Dental 837D Claim Information Application Progress WBilling Provider Edit W Subscriber Edit 7 Claim Informati Billing Provider MHCP PROVIDER Total Claim Charge Amount eae aerate Subscriber 01044759 FIFTYTEN M TESRECIPO2 Type of Claim Original Ciim senise quired Field Situational if applicable complete all fields v pc MN ITS User Guides Claim information der Website Electronic Claim Attachments Prior Authorization Number MHCP Payment Claim Claim Note Calendars Text Add Provider Training Chim No
36. Individual Practitioner o Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Contact Us The Subscriber screen is the second screen in the claim process As we continue to move through the screens the Billing Provider name continues to display On the subscriber screen you will enter the FFS MHCP recipient s member ID and their birthdate 44 Subscriber Application Progress IDental 837D Subscriber Application Progress MBilling Provider Edit Subscriber Claim Information B Billing Provider MHCP PROVIDER Claim Services Required fields Subscriber Related Links MN ITS User Guides Subscriber ID Birth Date Provider Website Electronic Claim Attachments Continue MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms Provider Enrollment NDC Search Questions or Comments Contact Us 2011 Minnesota Department of Human Services Online Updated 11 19 2012 13 22 17 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology The Application Progress feature in the upper right navigation is now updating our progress through the screens A checkmark in the box next to the screen name indicates we are on the Subscriber screen The box next to the Billing Provider screen name is now filled in indicating i
37. MHCP PaymentClaim Calendars Patient Control Number O Fee Schedule AssignmentPlan Participation Assigned NotAssigned Provider Ti q Benefits Assignment Yes O No O NotApplicable ronder Trainin MHCP Provider Profile Release of Information gt Yes Informed Consent Change Forms Provider Indicator Signature onFile Signature noton File c Individual Practitioner P o Diagnosis Code Add Organization Enter Diagnosis Code Provider Enrolimen Sequence Diagnosis Code NDC Search Delete Washington Publishin Company Situational Claim Information Questions or Comments ContactUs Other Providers Claim Level Back Cancel Continue The Situational Claim Information and Other Providers Claim Level sections are currently collapsed or closed Situational Claim Information Dental 837D Claim Information Billing Provider MHCP PROVIDER Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Required Field Claim Information amp PrintPage Total Claim Charge Amount Type of Claim Original Situationat if applicable complete all fields within a section Claim Frequency Code Original O Replacement O Void Payer Claim Control Number Place of Service 11 OF FICE Patient Control Number AssignmentPlan Participation Benefits Assignment Release of Information Provider Indicator Enter Diagnosis Code Diagnosis Code Sequence v Assigned O
38. New MN ITS Screens 837D Dental with Line Level COB Minnesota Health Care Programs MHCP Minnesota Department of Human Services Minnesota Health Care Programs Welcome to the Minnesota Health Care Programs webinar on the new MN ITS screen changes to the 837D Dental claim In this webinar we will review the new look and functionalities of the new 837D MN ITS screens We will also review how to submit a secondary claim with Third Party Liability also known as COB to MHCP to receive reimbursement at the line level The new screens became available on Monday September 9 2013 Agenda Using the Webinar New MN ITS Screen Layout amp Functionality New MN ITS User Guide Manual a Submit Interactive Claims 837D Request Status 276 Question amp Answer Minnesota Health Care Programs During this webinar we will discuss Using the Webinars features to successfully hear view the presentation and also how to submit your questions We will also review the new MN ITS screen layout and how to navigate throughout the applications including the new MN ITS User Guide Manual Submit Direct Data Entry DDE 837D Claims and Request Status 276 transactions There will be question and answer session following each section of the presentation today However you are welcome to submit questions at anytime during the presentation Tips on Using the Webinar Changing screen view Using Chat Private tab
39. NotAssigned Yes No NotApplicable gt Yes O Informed Consent Signature onFile Signature noton File Diagnosis Code Delete Situational Claim Information Other Providers Claim Level Back Cancel Continue Application Progress illing Provider Edit Im Subscriber Edit 7 Claim Information COB Claim Services Related Links MNATS User Guides Provider Websit MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms Individual Practitioner Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments ContactUs Next we will select the accordion panel for Situational Claim Information Situational Claim Information Commonly Used Fields Dental 837D Claim Information Billing Provider MHCP PROVDER 01044759 FIFTYTEN R TESTRECIPO2 We are now in the Situational Claim Information section indicated with an orange title The Claim Information section has collapsed and is displayed with a blue accordion panel above the opened situational claims information section The Situational Claim Information section contains information that may be required depending on the services performed There are double red asterisks next to several fields Throughout the new MN ITS screens Double red asterisks indicate fields that are situational If applicable complete all situatio
40. Only those where the 9 digit zip code are the same Consolidated providers must select the radio button next to the location that is associated with their claim Once selected the Billing Provider Information will auto populate with that locations address and taxonomy information into the billing provider information fields AbilerQ 1234667890 Logout Dental 837D Billing Provider Billing Provider Help A tthe Biling Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Biling Provider Information Organization HCP PROVIDER Taxonomy Address 1234 MAIN STREET Address Oy ATOW Telephone 651 431 2700 Stale MN Zip 55155 Continue Application Progress Y Biling Provider Subscriber LC Claim information C08 E m Senices Related Links MIUTS User Guides Provider Website Electronic Claim Attachment MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms In the upper right we have a Help link that provides an overview of all fields on the current screen As you move through the screens the help link when selected with display field information specific to the screen you are on Select the Help link to open the Billing Provider field help information Billing Provider Help Pop up C MN ITS Help 837D 8371 amp 837P Provider Microsoft Internet Explorer provided by DHS S
41. Situational if applicable complete all fields within a section MN ITS User Guides Payer a J4 Other Pay Primary Identifier s A parioa ns 123456 Health Insurance Co paced Paid Unit Count yme MHCP Provider Profile Change Forms COB Line Adjustments Entry Claim Adjustment Group Code Adj Reason Code Adj Amount Adj Quantity Select One v Adj Reason Code No records found Washington Publishing Compan Questions or Comments Situational Services Other Providers The other payer screen allows you to enter COB at the line level by entering the other payers line level adjustments and the amount they paid for each individual line First use the other payer primary identifier drop down menu to select the other payer ID and name for the payer that was entered on the COB screen 89 Other Payer Line Level Paid Amount amp Adjustment amp Prin Pental 837D Services MHCP PROVIDER 01044759 FIFTYTEN R TESTRECIPO2 COB Line Adjustments Entry Claim Adjustment Group Code CO Contractual Obligations Group Code Refer to the other payer s explanation of benefits or EOB as you will need to enter the Claim Adjustment Reason Codes and the associated Adjustment amounts If their EOB does not include HIPPA compliant reason codes refer to the Washington Publishing Companies Website on the right navigation menu to review the list of claim adjustment group and reason codes av
42. Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology From the right navigation menu select the Electronic Claim Attachment link for those claims that requires additional supporting documentation be faxed and connected electronically to your claim submission 26 Electronic Claim Attachments Skip to Main content Subnavigation Quicklinks f Ii MER DESEE of Homan Services Ense Search DHS HomePage Forms eDocs Countyand Tribal Workers A ZIopics About DHS Aging Partners amp Providers Children Disabilities Health Care Publications gt Partners and Providers gt MHCP enrolled providers MHCP enrolled providers MHCP Enrolled Providers MHCP provider toolbox BIKigICescrces Electronic Claim Attachments Communication Requirements for claim attachment submission have been standardized across Minnesota for Enrollment E3 MHCP requires only a limited number of claim attachments Claims with attachments are Industry Initiatives complex claims for prompt payment purposes Do not send paper claims with attachments Manual When you need to submit an electronic claim with an attachment follow these steps Eresenpuon anuo 1 R MHCP Attach k hi MHCP Attachment Criteria Hermaisi eview the ment Criteria to ensure that your claim attachment is necessary Adolescent services 2 Complete the AUC Cover Sheet for Health Care Claims required for all attachments across Adult
43. VERAGE More detailed information in letter Start 01 01 1995 Claim has been adjudicated and is awaiting payment cycle Start 01 01 1995 Balance due from the subscriber Start 01 01 1995 One or more originally submitted procedure codes have been combined Start 01 01 1995 Last Modified 06 30 2001 One or more originally submitted procedure code have been modified Start 01 01 1995 Last Modified 06 30 2001 Claim encounter has been forwarded to entity Note This code requires use of an Entity Code Start 01 01 1995 Last Modified 02 11 2010 Claim encounter has been forwarded by third party entity to entity Note This code requires use of an Entity Code Start 01 01 1995 Last Modified 02 11 2010 Entity received claim encounter but returned invalid status Note This code requires use of an Entity Code Start 01 01 1995 Last Modified 02 11 2010 Entity acknowledges receipt of claim encounter Note This code requires use of an Entity Code Start 01 01 1995 Last Modified 02 11 2010 Accepted for proc i Start 01 01 1995 Las The Claim Status Code 20 tells us the our claim has been accepted for processing With the new screens you may notice several new claim status category and claim status codes other than F1 and 65 Remember the Washington Publishing Company link is always available on the right side to assist staff determine how the line was processed Additional lines display as collapsed
44. accordion panels in blue with the line number and a general summary Providers must select each line to review the codes and payment information to thoroughly understand how the entire claim was processed Copy Replace Void Claim information Washington Publishing Company PA Questions or Bill Type D Senice Period 08 01 2013 Commeants Status Info Effective Date 08 17 2013 08 01 2013 Contact Us Total Claim Charge Amount 115 00 Payer Claim Control 91322900400000001 Number Pharmacy Prescription Number Claim Payment Amount 33 24 Claim Status Category Claim Status Adjudication Date 08 17 2013 P1 3 Remittance Date Trace Number 000000000 Service Line Information Line Number 01 Procedure D0140 Modifiers s Charge 95 00 Units 1 0 Serice Dates 08 01 2013 Claim Status Category Claim Status 08 01 2013 Payment 25 31 Revenue code Status Information Effective Date 08 17 2013 A1 20 Line Number 02 Procedure D0220 Modifiers s Charge 20 00 Units 1 00 At the bottom left side providers will have the option to Copy Replace or Void the claim This new feature will retrieve all of the entries that were made on the claim that was just submitted Refer to our Copy Replace and Void MN ITS user guide for instructions 129 Return to MN ITS Home Close Claim Information Washington Publishing Company Questions or Bill Type D Service Period 08 01 2013 CO Status Info Effective D
45. ailable Providers can easily access the link to WPC code lists during their claim submission In the Service line paid amount enter the amount that the other payer paid on this individual line If they paid zero enter 0 Paid unit count should always be 1 in the COB line adjustments entry subsection we selected from the drop down menu CO contractual obligation the corresponding reason code 45 and the amount of the provider write off 5 00 Select Add to save the entry Other Payer Line Level Paid Amount amp Adjustment Cont Dental 837D Services MHCP PROVIDER 01044759 FIFTYTEN R TESTRECIPO2 Related Links n The first COB line adjustments entry for line one displays in a table For the second adjustment in the COB line adjustments select from the drop down menu PR patient responsibility the corresponding adjustment reason code 1 deductible and the amount applied to the deductible 90 00 Select Add to save the entry Dental 837D Services Billing Provider MHCP PROVIDER Subscriber Required Field Line 2 Services Other Payer Other Payer Primary Identifier Service Line Paid Amount 0 0 COB Line Adjustments Entry Claim Adjustment Group Code Select One Claim Adjustment Group Code co PR Situational Services Other Providers 01044759 FIFTYTEN R TESTRECIPO2 Save View Line s Other Payer Line 1 COB Line Adjudication Entry Total Claim Charge Amount
46. al 837D Subscriber E3 Subscriber ID must be entered Date of Birth must be entered Subscriber Error Message Billing Provider MHCP PROVDER Required Field Subscriber Subscriber ID Birth Date Back Cancel Search Continue Application Progress WBilling Provider Edit 4 Subscriber Claim Information OB Claim Services Related Links MNHTS User Guides Provider Website Electronic Claim Attachments MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms o Individual Practitioner o Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Contact Us If you select either the search or continue action buttons without completing the required fields you will receive a message stating Subscriber ID must be entered Date of Birth must be entered 47 Subscriber Invalid Search Response Dental 837D Subscriber Application Progress amp Print Page nai WBilling Provider Edit Y Subscriber Claim Information OB E3 Subscriber not found Claim Services vider MHCP PROVDER Billing Provider MHCP PROVDE Related Links MNHTS User Guides Required Field Subscriber Provider Website Subscriber ID 01234567 Birth Date 03 22 1970 Search Electronic Claim Attachments MHCP Payment Claim Calendars Back Cancel Continue Eee Schedule Provider Training
47. an Services Online Updated 11 19 2012 10 43 19 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology Next on the right navigation menu the MHCP Payment Claim Calendars link allows providers to access the claim payment and cut off date calendars MHCP Payment Claim Calendars thei Minnesota Department of Human Services aes aano evenire caen pebiaes teonomie supers Heute melee Lee gt Partners and Providers gt MHCP enrolled providers MHCP Enrolled Providers MHCP Payment amp Claim Cut Off Calendar Calendars are in PDF format MHCP provider toolbox Billing resources Communication H Enrollment B Download the Calendar Industry Initiatives 2013 Payment amp Claim Cut Off Calendar NEW Manual 2012 Payment amp Claim Cut Off Calendar Prescription drug 2011 Payment amp Claim Cut Off Calendar information 2010 Payment amp Claim Cut Off Calendar Adolescent services 2009 Payment amp Claim Cut Off Calendar Spoken Language Adult mental health E 2008 Payment amp Claim Cut Off Calendar Health Care Ani series DHS is required to pay or deny clean claims within 30 days and complex claims within 90 days Clean claims are without attachments are Alcohol and drug f complex claims are replacement claims Medicare crossovers third party liability claims or daims with attachments amp Rules Child and Teen Checkups Washington Chil
48. ancel amp Print Page Total Claim Charge Amount 115 00 Type of Claim Original Situational if applicable complete all fields within a section Charges POS 95 00 20 00 Submit Validate Application Progress mBilling Provider Edit W Subscriber Edit Claim Information Edit Iw COB Edit v Claim Services Related Links MNHTS User Guides Provider Website Electronic Claim Attachments MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms o Individual Practitioner Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Providers can use the Edit action button to return to an individual service line to view or correct any fields Select the Edit action button Services Correct Fields using Edit Pental 837D Services Application Progress amp Print Page wBilling Provider Edit Subscriber Edit Billing Provider MHCP PROVIDER Total Claim Charge Amount 95 00 Claim Information Edit amp COB Edit Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original 2 Claim Services Situational if applicable complete all fields within a section Related Links MN ITS User Guides Required Field Line 2 Provider Website Electronic Claim Attachments Date of Service 2 From 08 01 2013 MHCP Payment Claim Calendars Place of Service
49. and line level to receive line level reimbursement On the COB screen enter the Name of the insurance carrier in the other payer name field And the Carrier ID in the other payer primary id field This number is found on the recipients MN ITS eligibility response listed in the other insurance section as the Carrier ID This 6 digit Carrier ID number is the number you should enter into the other payer primary ID field Next we will select a Claim Filing Indicator from the dropdown menu that best 75 describes the type of other insurance COB Claim Filing Indicator Other Insurance TPL Dental 837D COB Application Progress PrintPage mBilling Provider Edit m Subscriber Edit Billing Total Claim Charge lm Claim Information Edit Provider MHCP PROVIDER Amount E coB Claim Services Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original Related Links zRequired Field Situationat if applicable complete all fields within a section MNHTS User Guides 1 Provider Website Other Payer Electronic Claim Attachments Other Other MHCP Payment Claim Calendars Payer Health Insurance Co Payer 123456 Name Primary ID Fee Schedule Claim Provider Training Filing Select One M COT Select One 11 Other Non Federal Programs 12 Preferred Provider Organization PPO 13 Point of Service POS 14 Exclusive Provider Organization EPO Practitioner 15 Indemnity Insurance Org
50. anization 16 Health Maintenance Organization HMO Medicare Risk 17 Dental Maintenance Organization Provider Enrollment AM Automobile Medical BL Blue Cross Blue Shield MHCP Provider Profile Change Forms NDCSearch CH Champus z GE commercial Insurance Co Sad Washington Publishing Company FI Federal Employees Program gompany HM Health Maintenance Organization LM Liability Medical Questions or Comments MA Medicare Part A ContactUs After selecting the dropdown menu a list of other payer types will display Depending on which option you choose in the Claim Filing Indicator field more fields will display requesting information specific to that type of payer For general insurance coverage select Cl Commercial Insurance 76 COB Claim Level Entry For Line Level Adjudication Dentai 837Dy COB A slightly different set of fields for reporting commercial insurance now displays Next we completed the payer responsibility insured id which is the policyholder for the other payer and their relationship code These field are required at the COB claim level for all providers COB Claim Level Entry Adjustments Paid Amounts Dentali 837Dy COB Appii en PrintPaa der MHCP PROVIDER 01044759 FIFTYTEN R TESTRECIPO2 Do not complete the Claim Level Adjustments or Other Payer Amounts at the COB claim level These adjustments will be added at the Service Lin
51. ate 08 17 2013 08 01 2013 Contact Us Total Claim Charge Amount S 115 00 Payer Claim Control 91322900400000001 Number Pharmacy Prescription Number Claim Payment Amount 33 24 Claim Status Category Claim Status Adjudication Date 08 17 2013 P1 3 Remittance Date Trace Number 000000000 Service Line Information Line Number 01 Procedure D0140 Modifiers s Charge 95 00 Units 1 00 Service Dates 08 01 2013 08 01 2013 Payment 2531 Revenue code Status Information Effective Date 08 17 2013 Claim Status Category Claim Status F1 65 Line Number 02 Procedure D0220 Modifiers s Charge 20 00 Units 1 00 Replace Void When you are done reviewing the submit response select Close to return to the MN ITS Home page 130 New MN ITS Dental Claim Screens O ms Minnesota Health Care Programs Before we go into the new MN ITS screens for the Request Claim Status 276 277 would like to welcome any questions you may have about the new MN ITS Dental Claim screens Use the chat feature at the bottom left select the private tab and send your question to the leader and assistance group Request Claim Status 276 Skip to Main content Subnavigation Quicklinks He Minnesota Department of Human Services ABiller 1234567890 Logout hers Home TEST REGION Mailbox MNATS Eligibility Request 270 Authorization Request 278 Submit Transactions Request Claim Status 276 User Guid
52. cs Aging Partners amp Providers Children Disabilities Health Care Publications Licensing gt Partners and Providers gt MHCP enrolled providers gt Communication MHCP Enrolled Providers Contact MHCP provider toolbox Biling resources Information Communication News Updates E mail lists Provider Call Center Training For questions about fee for service coverage policies and billing procedures provided to Enrollment Minnesota Health Care Programs MHCP recipients contact the Provider Call Center or email Healthcare Providers Industry Initiatives Manual Voice 651 431 2700 or 1 800 366 5411 Related Pages MN ITS Use NDC Search to verify drug coverage Prescription drug TTY 711 or 1 800 627 3529 information Fax 851 491 7426 Adult mental health To verify MHCP recipient eligibility press 7 Alcohol and drug abuse To get MHCP related phone numbers addresses press 9 Child and Teen Checkups websites and general information Child care providers To reach the MHCP Provider Call Center press 1 then Child support Children s mental health 1 for an NPI County redesign 2 for an UMPI starting with A Disability services 3 for an UMPI starting with M Employment services manual For questions about MN IT istration MN ITS press 6 Food support outreach Administrator and Password Resets Grants and RFPs For enrollment questions get forms through the press 5 The contact information in the cente
53. ctronically via MN ITS Interactive or Batch Grants aridi RERS 4 Faxthe Cover Sheet and attachment s to MHCP at 651 431 7786 IEP providers Managed care Providers must send the attachment by end of next business day after submitting the electronic claim organizations MHCP will deny claims for lack of an attachment after three business days of receipt of the claim State LTC profile When you need to submit an electronic claim with an attachment follow these steps The Electronic Claim Attachments Webpage will display In the center section is a link to the AUC Cover Sheet for Health Care Claims Select the link to retrieve the document A ministrative Uniform COVER SHEET Unitormity For Health Care Claim Attachments NOTE To maximize use of this form use of Microsoft Word Committee version 2003 or later is recommended Select appropriate payer group purchaser from the drop down listor fill in the Other option TO Selectfax Select fax R Aetna 860 754 1590 Type payer group purchaser name and fax if not in drop down list America s TPA 952 896 0372 Blue Cross Blue Shield of MN 800 793 6928 HeakhPartners Medical 952 053 0060 se your arrow keys to navigate to the next or previous text field Delta Dental of MN 866 516 5616 For specific field directions refer to the HealthPartners Dental 952 853 8861 Instructions Medica Health Plan 801 994 1076 Metropolitan Health Plan 612 677 6052 lumber
54. d care providers Publishing Co Child support E H ReportRate this page Children s mental health County redesign Disability services Employment services manual t Food support outreach Grants and RFPs i The Webpage contains calendars for the current year and also several years past As well as links on how to read the payer claim number PCN and use the Julian calendars to verify the date the claim was received by MHCP Providers may find it helpful to know the claim cutoff date to ensure you are able to submit claims and receive an acknowledgement during the current remittance advice cycle We suggest providers bill early and often don t wait to bill on the cutoff date 29 Fee Schedule Dental 837D Billing Provider 9 Print Page amp If the Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Billing Provider Information Organization MHCP PROVIDER Taxonomy Address1 1234 MAIN STREET Address2 City ANYTOWN State MN Zip 55155 Telephone 651 431 2700 Application Progress Y Billing Provider Subscriber Claim Information COB Claim Services Related Links MN ITS User Guides Provider Website Electroni laim Attachment MHCP Payment Claim Calendars lom 707 Cancel Continue Provider Training MHCP Provider Profile Change Forms o Individual Practitioner O Organization Provider Enrollmen NDC Search
55. display for each type of grouped User Guides In the center section these groups will list the individual user guides that are associated to that specific group For example under 837D Dental providers can view the actual screen shots for the dental claim and are able to access the step by step instructions for submitting claims using the MN ITS 837D Line Level COB user guide 25 Provider Website Dental 837D Billing Provider Application Progress 9 Print Page V Billing Provider Subscriber amp If the Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Claim Information COB Billing Provider Information Claim Services Organization MHCP PROVIDER Taxonomy Related Links MN IT Address1 1234 MAIN STREET MN ITS User Guides Provider Website Address2 inopia Electronic Claim Attachments City ANYTOWN state mn Zip 55155 lectronic Claim Attachments MHCP Payment Claim Telephone 651 431 2700 Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms Cancel Continue o Individual Practitioner Organization Provider Enrollment NDC Search Washington Publishing mpan Questions or Comments 2011 Minnesota Department of Human Services Online Updated 11 19 2012 10 43 19 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology Ne
56. e level in the other payer accordion section Providers who should enter COB at the line level include all dental providers who receive fee for service reimbursement from MHCP Providers who receive an encounter rate should attend the webinar 837D Dental Claim Level COB for the correct instructions on submitting secondary claims to MHCP COB Screen TPL Claim Level Dental 837Dy COB Billing Provider MH CP PROVIDER 01044759 FIFTYTEN R TESTRECIPO2 P 18 Seif Next in the other insurance information fields benefits assignment and release of information are defaulted with the standard response yes Again if the default response is incorrect select the radio button for the response that best describes the actual documentation on file 79 ental 837D y COB Billing Provider AHCP PROVIDER Subscriber Required F 1 Other Payer OtherPayer Nec Health Insurance Co Claim Filing Indicator Other Payer Subscriber Payer Responsibility P Primary Claim Level Adjustments Claim Adjustment Group Code Select One Claim Adjustment Group Code No records found Other Payer Amounts Payer Paid Amount Other Insurance Information Benefits Assignment ves No Release of Information ves lt Delete So Save COB Entry 01044759 FIFTYTEN R TESTRECIPO2 Total Claim Charge Amount Type of Claim OtherPayer PrimarylD Ci Commercial Insurance Co Insured io Adj Reason Code
57. e Lists and X12 Registry Reference gt Code Lists gt Health Care gt Health Care Claim Status Codes ASC X12 External Code Source 508 LAST UPDATED 7 1 2013 Health Care Claim Status Codes convey the status of an entire claim or a specific service line For the health of all Filter Codes by Status Show AJ O Cannot provide further status electronically NEED 30 60 Start 01 01 1995 OR 90 TA 4 For more detailed information see remittance advice HEA Start 01 01 1995 COVERAGE 2 More detailed information in letter Start 01 01 1995 3 Claim has been adjudicated and is awaiting payment cycle Start 01 01 1995 6 Balance due from the subscriber Start 01 01 1995 Claim status code 3 tells us the claim has been adjudicated and is awaiting the payment cycle The other codes on the service line were A1 and 20 We verified A1 is a good code on our validate response Since we are still in the claim status codes list we can now verify status code 20 WPC Claim Status Codes Health Care Claim Status Codes ASC X12 External Code Source 508 AS Reference gt Code Lists gt Health Care gt Health Care Claim Status Codes convey the status of an entire claim or a specific service line For the health of all Filter Codes by Status Show A Current Cannot provide further status electronically NEED 30 60 Start 01 01 1995 OR 90 DAY For more detailed information see remittance advice HEALTH Start 01 01 1995 CO
58. e Schedule Provider Training MHCP Provider Profile Change Forms c Individual Practitioner o Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments ContactUs 91233300400000008 Claim Status The search results will display a single response for the claim that matches your search or if multiple claims match your search entry they will display in an accordion panel format The response opens with the first claim and displays the additional claims as a collapsed accordion in blue with a search result number and Control of the claim Only the 10 most recently processed claims for the search criteria used will display in the search results Be sure to narrow your search by entering as much information as you have into the search fields At the top of the screen a message displays stating Claim Status This claim was previously submitted for processing If you want to return to the Request Claim Status simply close the response page New MN ITS Screens 837D Dental Any Questions Thank you and remember to visit our Website www dhs state mn us provider Minnesota Health Care Programs MHCP Minnesota Department of Human Services Provider Relations 2012 amp 2013 Minnesota Health Care Programs Additional trainings and webinars are available and listed on the Provider Training page which is located under Communications link on our MHCP Enrolled P
59. ectronic Claim Attachments MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms o Individual Practitioner o Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Back on the Services Line Table summary screen providers may use the Application Progress feature in the upper right to return to any of the screens by selecting Edit next to the screen that needs to be corrected Once the correction is made providers can once again validate their claim and review both of the claim status codes again If no errors are found select Submit to submit the claim to MHCP for processing 121 Submit Response Submission Response This claim has been submitted for processing Related Links amp Print Page MN ITS User Guideg Provider Website Minnesota Department of Human Services 08 17 2013 10 31 41 1674742 Electronic Claim MHCP Provider Call Center Attachments 651 432 2700 or 1 800 366 54 1149 MHCP Payment Cla Calendars 01 Contro 2 01 2013 Fee Schedule Receiver Provider Training NPI UMPI 1234567890 Name MHCP PROVIDER MHCP Provider Pr Change Forms Provider o Individual NPI UMPI 1234567890 Name MHCP PROVIDER Practitioner Organizatio Subscriber Provider Enrollment ID Number 01044759 Name FIFTYTEN TESTRECIP02 Patient Control Number TESTRECIP02 NDC Search Claim Information Washi
60. eplacement Date Copy Delete Application Progress Billing Provider Edit Subscriber Edit W Claim Information Edit COB Edit 7 Claim Senices inks ser Guides Related L MN ITS Provider Website Electronic Claim Fee Schedule ompan Questions or Comments Contact Us One of the new fields on the situational services screen is the Fixed Form Information field At this time this field is not required on the dental claim Situational Services Tooth Oral Cavity amp Placement Status IDental 837D Services Billing Provider MHCP PROVIDER Total Claim Charge Amount 95 00 Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Situational if applicable compl Dependent on the services your are submitting you may need to complete some of the other situational services fields The Tooth information section is used to report tooth numbers and surfaces or oral cavity designations as appropriate For a service with multiple tooth surfaces providers must select the tooth number and the single surface then select the Add button Providers must repeat this process until each surface has been added MHCP will process all surfaces reported for that one tooth number as one service line Providers can not report more than one tooth number on a service line For a service with multiple oral cavity designations providers must select the oral cavity designation code then select the Add button
61. er payments and adjustments will display in a table Again make sure the line paid amount and the total adjustment amounts equal the individual lines charge or they will deny for being out of balance The total submitted charge for the second line was 20 00 and the total payment and adjustments amount equals 20 00 To change or review the COB information select Edit from the COB summary table Again only select the Add action button directly under the COB summary table if there was an additional other payer Additional Accordion Panels Dental 837D Services Application Progress amp Print Page Billing Provider Edit Subscriber Edit Billing Provider MHCP PROVIDER Total Claim Charge Amount 115 00 Claim Information Edit COB Edit Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original 7 Claim Services Required Field Situational if applicable complete all fields within a section Related Links MN ITS User Guides Line 2 Provider Website Services Electronic Claim Other Payer Attachments MHCP Payment Claim COB Line Payments Adjustments CEGRES Other Payer Primary Identifier Name Line Paid Amount Total Adj Amt Fee Schedule 01 123456 Health Insurance Co 10 00 10 00 Provider Training MHCP Provider Profile Change Forms o Individual Practitioner Situational Services o Organization Other Providers Provider Enrollment NI rch Save View Line s Copy Delete Washingto
62. ervice line Filter Codes by Status Show All Current To Be Deactivated Deactivated Cannot provide further status electronically Start 01 01 1995 4 For more detailed information see remittance advice Start 01 01 1995 2 More detailed information in letter Start 01 01 1995 3 Claim has been adjudicated and is awaiting payment cycle Start 01 01 1995 6 Balance due from the subscriber Start 01 01 1995 Watch a Free Demo One or more originally submitted procedure codes have been combined Start 01 01 1995 Last Modified 06 30 2001 No Contract No Set Ue F No Long Term Commitments One or more originally submitted procedure code have been modified Start 01 01 1995 Last Modified 06 30 2001 Claim encounter has been forwarded to entity Note This code requires use of an Entity Code Start 01 01 1995 Last Modified 02 11 2010 Claim encounter has been forwarded by third party entity to entity Note This code requires use of an Entity Code Start 01 01 1995 Last Modified 02 11 2010 Entity received claim encounter but returned invalid status Note This code requires use of an Entity Code Start 01 01 1995 Last Modified 02 11 2010 49 Entity acknowledges receipt of claim encounter Note This code requires use of an Entity Code Start 01 01 1995 Last Modified 02 11 2010 Bil Acceptes tor processin wn Start 01 01 1995 Last Modified 06 30 2001 For the health of all T
63. es Last Check Provider Lists Individual PCAs Provider Lists User Administration MN ITS Your access to MN ITS functions and applications on the left menu has been tailored based on the services you provide Your MN ITS Administrator may further restrict your views access Learn which functions and applications apply to your provider type and contact your MN ITS Administrator with questions These functions listed below represent an exhaustive list and may not appear for each user Eligibility Request 270 Look up subscriber eigibiity and coverage and receive an Elgibilty Response 271 Verify eligibiity for up to SO recipients at a time by using the Mutiple Eigibiity Inquiry function Authorization Request 278 Create and subm authorization requests Service Agreement Request 278 Create and submt service agreement requests Submit Transactions Submit and view history for X12 production batch X12 test batch and miscellaneous ie affiliation data supplemental payments etc transactions Submit Interactive Claims 837 Submit claims directly to MHCP Request Claim Status 276 Check the status of a submitted claim Batch Submitters Refer to 010 0 0 Related Pages Troubleshooting Guide MHCP Paymi laim ff Cal If e MHCP Fi e X12 NCPDP Submitters Provider Updates Provider Website e Sign Up for Email Lists e Test Region Related Links e Washington Publishing Company NDC
64. evel II Optional The MN ITS Provider Point Administrator PPA acts as an assistant to the MN ITS PA PPAs can perform most of the same functions as the MN ITS PA for Level users The MN ITS PA must reset the PPA s password The PA can assign one or more PPAs to function in this role Level I Has general user access to MN ITS Users may be assigned to some or all of the MN ITS functions as designated by the T The MN ITS Administration page contains an overview of information intended for your organization s MN ITS Primary Administrator such as User levels within a providers MN ITS account and each of their roles and responsibilities MN ITS Registration User Guide Once registered the MN ITS Primary Administrator or a Secondary administrators can use this page to find User Guides on how to Create and assign access to new users Reset passwords for users And disable users who no longer need access or have left your office Next from the left navigation menu select Direct Data Requests 21 MN ITS User Manual Skip to Main content Subnavigation MN ITS User Manual EN MN ITS User Manual Direct Data Requests Advanced Search ft Minnesota Department of Human Services Table of Contents MN ITS User Manual Direct Data Requests MN ITS Administration Direct Data Requests Direct Data Entry Eligibility Verification Authorization Request Direct Data Entry DDE is a HIPAA compliant feature that allow
65. g Provider Subscriber Claim Information Claim Services Related Links MNHTS User Guides Provider Website Electronic Claim Attachments MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms Questions or Comments Contact Us olicy Contact DHS Top of Page I North Star is led by the Office of Enterprise Technology The first related link is MN ITS User Guides Our new MN ITS User Manual Webpage is where the User Guides will be available for providers to access As a result of the claim screen changes the user guides also needed updating You may want to access a specific user guide while in the new claim transaction especially when using the new screens for the first few times Select MN ITS User Guides 18 MN ITS User Manual Skip to Main content Subnavigation MN ITS User Manual EN MN ITS User Manual Advanced Search s MN ITS User Manual Home MN ITS Administration Duoct pu Huet MHCP MN ITS User Manual Home Submit DDE Claims f Ki Minnesota Department of Human Services This online MN ITS User Manual contains user guides to assist with using various features and functions within MN ITS On the menu to the left Review the Provider User Guide Table of Contents Access User Guides for information and instructions about all MN ITS features and functions available MN ITS user guides provide step by step
66. ganization MHCP PROVIDER Fasdomy Related Links MN ITS User Guides Address1 1234 MAIN STREET t Guid Address2 Provider Website Electronic Claim Attachments City ANYTOWN State MN zip 55155 Electronic Claim Attachments MHCP Pa Calendars Telephone 651 431 2700 Fee Schedule MHCP Provider Profile Change Forms NDC Search Washington Publishing Company Questions or Comments Contact Us 2011 Minnesota Department of Human Services Online Updated 11 19 2012 10 43 19 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology From the right navigation menu select the MHCP Provider Profile Change Forms link These change forms are used to update your individual or organizational provider specific information When the form has been completed and signed fax the form to provider enrollment using the fax number listed on the form Completed change forms will be processed within 30 business days from the date they were received 34 Provider Enrollment Dental 837D Billing Provider amp Print Page Z If the Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Billing Provider Information Organization MHCP PROVIDER Taxonomy Addressi 1234 MAIN STREET Address2 City ANYTOWN State MN Zip 55155 Telephone 651 431 2700 Cancel Continue Application Pr
67. he claim status codes Next lets review the WPC code list for P1 and 3 WPC HIPAA Compliant Code Lists CE LEE UC CEN C773 Reference X12 Registry A complete listing of every A family of standards The Implementatio care and Medicai Technical Rep sim nm N subscription or printed lists 100 Free Medical Billing SOFTWARE COMPREHENSIVE amp COMPLETE Begin Billing IMMEDIATELY Property amp Casualty Code Lists eral EDI Related Prop amp Casualty Code Lists From here we will select the Claim Status Category Codes link WPC Claim Status Category Codes Claim Status Category codes indicate the general category of the status accepted rejected addi requested etc which is then further detailed in the Claim Status Codes Supplemental Acknowledgements AD Acknowledgement Forwarded The claim encounter has been forwarded to another entity Start 01 01 1995 A1 Acknowledgement Receipt The claim encounter has been received This does not mean that the claim has been accepted for adjudication Start 01 01 1995 Acknowledgement Acceptance into adjudication system The claim encounter has been accepted into the adjudication system Start 01 01 1995 Acknowledgement Returned as unprocessable claim The claim encounter has been rejected and has not been entered into the adjudication system Start 01 01 1995 A4 Acknowledgement Not Found The claim encounter can not be found in the adjudication system S
68. he claim status code 20 tells us the claim has been accepted for processing Close the WPC code list and return to the validate response Validate Response Close Claim Information shington Publishing Company Questions or ill Type vice Peri 8 Bill Typ D ice Period 06 01 2013 Comments Status Info Effective Date 01 01 0001 08 01 2013 Contact Us Total Claim Charge Amount 115 00 Payer Claim Control Number Pharmacy Prescription Number Claim Payment Amount S 0 00 Claim Status Category Claim Status A1 0 Trace Number 000000000 Service Line Information Senice Dates 08 01 2013 Claim Status Category Claim Status 08 01 2013 Payment S 0 00 Revenue code us Information Effective Date 01 01 0001 A1 20 Line Number 02 Procedure D0220 Modifiers s Charge 20 00 Units 1 00 To return to the claim select the Close action button at the bottom right Select Submit IDental 837D Services amp Print Page Billing Provider MHCP PROVIDER Total Claim Charge Amount 115 00 Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original Required Field Situational if applicable complete all fields within a section Line From ro Charges POS 1 08 01 2013 95 00 11 Edit 2 08 01 2013 20 00 11 Edit EUG Validate Application Progress Billing Provider Edit Subscriber Edit Claim Information Edit COB Edit 7 Claim Services Related Links MN ITS User Guides Provider Website El
69. iant codes can be viewed using the right navigation menu Washington Publishing Company link to look up the codes 112 WPC HIPAA Compliant Code Lists CE LEE UC CEN C773 Reference X12 Registry A complete listing of every A family of standards The Implementatio care and Medicai Technical Rep sim nm N subscription or printed lists 100 Free Medical Billing SOFTWARE COMPREHENSIVE amp COMPLETE Begin Billing IMMEDIATELY Property amp Casualty Code Lists eral EDI Related Prop amp Casualty Code Lists From here we will select the Claim Status Category Codes link WPC Claim Status Category Codes CECCI CT UTE Reference Code Lists and X12 Registry Reference gt Code Lists gt Health Care gt Claim Status Category Codes ASC X12 External Code Source 507 LAST UPDATED 7 1 2013 Claim Status Category codes indicate the general category of the status accepted rejected additional information n which i letailed in the Claim Status Codes For the health of all Filter Codes by Status Show Al Current To Be Deactivated NEED 30 60 OR 90 DAY Acknowledgements A0 Acknowledgement Forwarded The claim encounter has been forwarded to another entity M OVERAGE Start 01 01 1995 Acknowledgement Receipt The claim encounter has been received This does not mean that the claim has been accepted for adjudication Start 01 01 1995 Acknowledgement Acceptance into adjudication system The claim e
70. ider Agencies Waiver Alternative Care AC Billing Labs Provider Record Review amp 245D License Waiver and Alternative Care Provider Training 101 Live in personiLab Training for PCA Provider Agencies Waiver Alternative Care AC Billing Labs Types of Trainings Webinars MHCP offers many workshops through webinar as well as in person Webinar attendees will connect to the webinar from their own computers and do not need special hardware or software communicate with the presenters and others in the audience using the chat feature available as part of the webinar session Attending Webinar Participants need the following to attend the webinar sessions Related Links In the center section you can view available MHCP training opportunities and online recorded basic Webinars that can help if you find yourself struggling with the submission of a claim or want additional information or a refresher Look for Training Materials on the link MN ITS Direct Data Entry DDE New Screen and Functionality Changes Once on the webpage select the link titled Training Materials MHCP Provider Profile Change Forms Dental 837D Billing Provider Application Progress amp Print Page es 7 Billing Provider Subscriber If the Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Claim Information COB Billing Provider Information Cian Sencan Or
71. iller 12345678 Password CISS MN ITS requires strong passwords MN ITS Important Notices MN ITS is available Please continue to submit claims In order to resolve intermittent activity and user administration issues MHCP had to restore the MN ITS User Administration function back to 10 8 12 You will need to recreate any new users added to your account or resubmit any user changes modifications or password resets made on 10 9 12 through 10 19 12 Payments for any paid claims received before 11 59 PM on 10 18 12 will be paid on 10 23 12 following the normal payment schedule The Department will work with providers who experienced any payment delays due to the MN ITS intermittent activity issues that began on 10 18 12 When working within the MN ITS User Administration function select the MN ITS Home logo at the top of the page to return to the MN ITS menu options MN ITS Administration Some users are experiencing errors while attempting to navigate modify or save a MN ITS user profile MHCP is aware of this issue If you receive errors review the MN ITS Troubleshooting Guide for a potential temporary resolution until the issue is permanently resolved 5010 D 0 Important Notices Review the 5010 D 0 Web page for information about billing testing issues and resolutions for both MN ITS Direct Data Entry DDE and Batch Submitters Messages include information about Medicare crossovers 5010 testing Submitting batch files
72. im Frequency Code Original Replacement Void Payer Claim Control Number Electronic Claim Attachmer Place of Service 1 1 OFFICE x MHCP Payment Claim Calendars Patient Control Number e Fee Schedule AssignmentPlan Participation Assigned NotAssigned A o O O Provider Training Benefits Assignment gt Yes No NotApplicable Tour x MHCP Provider Profile a Oo Release of Information Yes Informed Consent Change Forms Provider Indicator Signature onFile Signature noton File Enter Diagnosis Code Diagnosis Code equence NDC Search 1 V Washington Publishing Company Situational Claim Information Questions or Comments Other Providers Claim Level ContactUs The Claim Information screen contains three sections that open and close as you select them The screen opens displaying the Claim Information section with an orange title The other two sections below Situational Claim Information and Other Providers Claim Level are display in a blue panel across the screen indicating they are closed These sections are called accordion panels First let s discuss the Claim Information section 52 Replacement Void Radio Buttons Protected Fields Dental 837D Claim Information Application Progress 9 PrintPage Billing Provider Edit M Subscriber Edit Claim Information COB Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original GERE Bill
73. im Services Related Links MNATS User Guides MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms Individual Practitioner c Organization ProviderEnrollment NDC Search Washington Publishing Company Questions or Comments ContactUs A diagnosis code is now required on all claim types The new MN ITS screens diagnosis field will be defaulted on the Dental Claim with V72 2 for General Dental Examination Providers can also add additional diagnosis codes for the claim by entering the appropriate ICD9 code and selecting the Add action button to save the entry 57 Claim Information All Required Fields Completed Dental 837D Claim Information Application Progress Print Pag EE Billing Provider Edit E Subscriber Edit Claim Information Billing Provider MHCP PROVIDER Total Claim Charge Amount COB Subscriber 01044759 FIFTYTEN M TESRECIPO2 Type of Claim Original Claim Services Related Links z s plicable p within a sect S Required Field Situational if applicable complete all fields within a section MNATS User Guides Provider Website Claim Frequency Code Original O Replacement Void Payer Claim Control Number Electronic Claim Attachments Place of Service 11 OFFICE MHCP Payment Claim Calendars Patient Control Number Testrecip02 lt C Fee Schedule Assignment Plan Participation Assigned O Not As
74. ing Provider MHCP PROVIDER Total Claim Charge Amount Related Links Required Field Situationat if applicable complete all fields within a section MNUTS User Guide orm Provider Website Claim Frequency Code Original Replacement Void Payer Claim Control Number Place of Service 1 1 OFFICE MHCP Payment Claim Calendars Patient Control Number Fee Schedule Assignment Plan Participation Assigned NotAssigned P 2 Provider Training Benefits Assignment Yes No NotApplicable a y eo MHCP Provider Profile Release ofInformation Yes O Informed Consent Change Forms Provider Indicator SignatureonFile Signature notonFile Individual Enter Diagnosis Code Practitioner A Organiza Diagnosis Code Organization Provider Enrollment Sequence Diagnosis Code NOC Search 1 Washington Publishing Company Situational Claim Information Questions or Comments Other Providers Claim Level ContactUs Back Cancel Continue Providers use radio buttons to select options for specific fields such as the Claim Frequency Code field Providers may choose to select Original Replacement or Void a claim The Payer Claim Control number field cannot be modified when the radio button selected is for an original Claim 53 Payer Claim Number Dental 837D Claim Information Application Progress 9 PrintPage Billing Provider Edit amp Subscriber Ed
75. inue to move Services Line Level Entry Application Progress amp Print Page Bining Provider Edit E Subscriber Edit Billing Provider MHCP PROVIDER Information Edit Total Claim Charge Amount Edit Subscriber 01044759 FIFTYTEN M TESRECIPO2 Type of Claim Original Related Links nal if applicable ci fields within a section MNATS G Date of Service From Place of Service 11 OF FICE Provider Training Procedure Code Modifiers MHCP Provider Profile Procedure Code ard Du Change Forms Modifier Modifier 1st 2nd Modifier Modifier Diagnosis Pointer s select one select one select one e Provider Enrollment ine Item Charge Line item Charo Procedure Count Amount rch Other Payer Situational Sery Questions or Comments Other Provis Contact Us Save View Line s Copy Delete ADD Back Cancel The accordion panels at the line level are similar to the header or what is called the claim level On the top right side the Application Progress shows we are now on the Claim Services screen Services Modifiers ental 837D S Application Progress Billing Provider Edit Subscriber Edit Ae re Claim Information Edit Billing Provider MHCP PROVIDER Total Claim Charge Amount i COB Edit JACOB Edt 01044759 FIFTYTEN M TESRECIPO2 Type of Claim riginal Ced 11 OFFICE MHCP Provider Profile Change The Services screen contains multiple sections Again the sec
76. ion Number Claim Note Entry Text No records found Attachments Control Number Control Number Type ID 18ATK Claim Note Total Claim Charge Amount Type of Claim hment Type Description R CLAIM Original al if applicable c on Accident Information Related Causes Other Providers Claim Level Back Cancel Application Progress MBilling Provider Edit m Subscriber Edit 7 Claim Information cos Claim Services Related Links Electronic Claim Attachments MHCP Payment Claim Calendars Provider Trainin MHCP Provider Profile Change Forms aton Publishing Questions or Comments Contact Us Once the claims attachment information is saved providers can go the right navigation menu and select Electronic Claims Attachment to retrieve the AUC cover sheet Electronic Claim Attachments Skip to Main conten ubnavigation Quicklink tia Minnesota Department of Human Services A Search eod Search __Aboutons Aaing __ Bariners amp Providers Cien Qieabities Economic Supports Heaincare Puticatons Licensing gt Partners and Providers gt MHCP enrolled providers Related Pages MHCP Enrolled Providers MNATS MHCP provider toolbox Billing resources Communication Electronic Claim Attachments Requirements for claim attachment submission have been standardized across Minnesota for E3 MHCP requires only a limited number of claim attachments Claims with
77. ions Batch Submission Skip to Main content Subnavigation MN ITS User Manual Advanced Search MN ITS User Manual Submit Direct Data Entry DDE Claims MHCP user guides provide step by step instructions to help providers and billers use the Submit Claim 837 feature of MN ITS using DDE The user guides list which MN ITS fields you must complete on 837 claims when requesting MHCP reimbursement for health care services 837D Dental Review New MN ITS DDE Screens Dental 837D for pictures and description of the new screens 837D Dental Claim Level COB Intended for use by FQHC RHC amp IHS receiving encounter rates 837D Dental Line Level COB Intended for use by all other dental providers receiving fee for service FFS rates 8371 Institutional Inpatient Services Outpatient Services Outpatient Ambulance Outpatient Chemical Dependency CD Inpatient CD Outpatient me Care Non Long Term Care LTC Services Outpatient Rehabilitation Services OT PT and SLP 837P Professional Review New MN ITS DDE Screens Professional 837P for pictures and description of the new screens Basic Instructions All other services Ambulance Services Child and Teen Checkups C amp TC If you are reviewing your training materials for this webinar this screen has been updated but the process to get here has not changed On the left navigation menu under Submit DDE Claims subsections will
78. is collapsed Remember to select each line to review both of the claim status codes using the WPC link on the right navigation menu We know that A1 means that the claim has been acknowledged but not accepted for adjudication So next lets look at the WPC code list to review the claim status 20 117 WPC HIPAA Compliant Code Lists CINES LIEN C CEN C LJUPC vnin Reference 2 Re Code Lists ASC gt ssists several organizations in the maintenance and on of code lists external to the X12 family maintained by the Centers f vices CMS The Na al Unifi standards The icere and Medicaid and committees that meet during standing X12 meetings Health Care Code Lists Claim Select the claim status codes link X12 Registry A complete listing of every ASC X12 Implementation Guide IG and Technical Reports Types 2 and 3 TR2 TR3 Includes description reg tion publication dates and contact information Code Lists for Purchase as electronic CSV files email change slert or printed lists W s Task Grou ical Report Task maintains a collectio 100 Free Medical Billing SOFTWARE COMPREHENSIVE amp COMPLETE Begin Billing IMMEDIATELY gt ASC X12N T WPC Claim Status Codes Reference gt Code Lists gt Health Care gt Health Care Claim Status Codes ASC X12 External Code Source 508 L UPDATED 7 1 2013 Health Care Claim Status Codes convey the status of an entire claim or a specific s
79. it COB Edit 7 Claim Services Total Claim Charge Amount 95 00 Type of Claim Original Situational if applicable complete all fields within a section Related Links MN ITS U Guides Provider Website Electronic MHCP Payment Claim lendars chedule Provider Training MHCP Provider Profil Change Forms Code Tooth Surface Practitioner S Organization No records found Provider Enrollmen Code NOC Search No records found Washington Publishing Company Prior Placement Date Questions or Comments Replacement Date Contact Us Copy Delete Select the Other Providers accordion panel Other Providers Line Level Providers Dental 837D Services Application Progress amp Print Page Billing Provider Edit Billing Provider MHCP PROVIDER Total Claim Charge Amount 95 00 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original Situational if applicable complete all fields within a section Provider Identifier NPUUMPI Add Name Address 1234 MAIN STREET gt A DOE POS ANYTOWN MN 55155 The other providers screen opens displaying the rendering provider that was entered and selected at the claim level You do not have to make any entries or changes to the line If this is the provider who rendered the service If you need to identify a different rendering provider for this service line enter that providers NPI or UMPI then select the Add button and next select the Radio Butto
80. it v BillingProvider MHCP PROVIDER Total Claim Charge Amount cm Information E Related Links Required Field situationat if applicable complete all fields within a section MNHTS User Guide Claim Information Provider Website Claim FrequencyCode Original O Replacement Void Payer Claim Control Number Electronic Claim Attachments Place of Service 11 OFFICE Y MHCP Payment Claim Calendars Patient Control Number Fee Schedule AssignmentPlan Participation gt Assigned NotAssigned Provider Trainin Benefits Assignment Yes O No O NotApplicable MHCP Provider Profile Release ofInformation Yes Informed Consent Change Forms Provider Indicator gt Signature onFile Signature noton File Individual Enter Diagnosis Code Practitioner Diagnosis Code c Organization Provider Enrollment Sequence Diagnosis Code NDC Search 1 Delete Washington Publishing Company Situational Claim Information Questions or Comments ContactUs Other Providers Claim Level Back Cancel Continue When Replacement or Void is selected the type of claim will change and the Payer Claim Control Number field turns white to allow provider to enter the payer claim number of the claim they are trying to replace or void 54 Dropdown Menus Dental 837D Claim Information Application Progress PrintPage illing Provider Edit ubscriber E dit Billing Pr
81. ividual Practitioner o Organization Provider Enrollment Washington Publishing Company Questions or Comments The Services Line Table will display once again for you to review your lines Provider should Validate their claim before submitting to reduce the chance of errors or denied claims MHCP s timely billing guidelines are as follows All claims must be sent correctly and received no later than 12 months from the date of service so they can be properly adjudicated Replacement claims sent to adjust a payment must be received within 6 months of the incorrect payment date or within 12 months from the date of service whichever is greater MHCP claims that were denied due to system error or incorrect information from the county such as retroactive coverage may also be resubmitted within 12 months of the date of service or up to 6 months from date of county correction whichever is greater Claims related to county corrections require providers to submit a copy of the dated counties letter as supporting documentation as an electronic claims attachment Claims over one year old must be sent as an claims attachment with appropriate dated documentation MHCP will review documentation but does not guarantee payment Once you select Validate you may see a message stating Your claim is processing please wait Validate Response Summary and Claim Information Validate Response Only This claim has not been submitted for
82. l be defaulted with the From date or you may enter a different date to search for a span of dates Using a span of dates may result in multiple claim responses being displayed 134 Detail Search tha Minnesota Department of Human Services Abiller 1234567890 Logout Health Care Claim Status Request Required Field Quick Search Subscriber ID 01044759 Serice Date From 12 03 2012 Pay To Provider NPI UMPI Detail Search Payer Claim Control Number Pharmacy Prescription Number Submit Skip to Main content Subnavigation Quicklinks Chers Home Service Date To north Star Related Links MNATS User Guides Pri rt Websil Electronic Claim Attachments MHCP Payment Claim Calendars E hedul Provider Training MHCP Provider Profile Change Forms Individual Practitioner o Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments e Contact Us In addition to completing the required fields you can choose to narrow your search criteria by using the Detail Search section to enter the Payer Claim Number of the claim you are requesting 135 Quick Search Submit Skip to Main content Subnavigation Quicklinks ths Minnesota Department of Human Services Abiller 1234567890 Logout Health Care Claim Status Request Required Field Quick Search Subscriber ID 01044759 Service Date From 12 03 20
83. laim COB Line Payments Adjustments Calendars Other Payer Primary Identifier Name ine Paid Amount Fee Schedule 01 123456 Health Insurance Co Provider Training MHCP Provider Profile Change Forms Situational Services Other Providers Questions or Comments A summary displays the total COB line payments adjustments that were entered for line one It is important that the line paid amount and the total adjustment amounts equal the individual lines submitted charge The total submitted charge for line one equals 95 00 and the total payment and adjustments amount equals 95 00 If the amounts did not equal the claim line would deny for being out of balance To change or review the information select Edit from the COB line payments adjustments summary table to return to the other payer line level COB entry If there was an additional other payer entered at the COB Header Claim level select the Add action button to enter COB line payment and adjustment for this line In our example there is only one payer Situational Services Accordion Panel Dental 837D Services Billing Provider MHCP PROVIDER Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Required Field Line 1 Services Other Payer COB Line Payments Adjustments Other Payer Primary Identifier Name 01 123456 Health Insurance Co Other Providers Save View Line s Cancel amp Print Page Total Claim Charge Amount 95 00 Type of
84. lectronic Claim Attachment MHCP Payment Claim Telephone 651 431 2700 Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms Cancel Continue Individual Practitioner o rganization Provider Enrollment N rch Washington Publishing M mt Questions or Comments Contact Us 2011 Minnesota Department of Human Services Online Updated 11 19 2012 10 43 19 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology From the right navigation menu a link to the Washington Publishing Company HIPAA compliant code lists is now available from any screen during your claim submission Select Washington Publishing Company 38 WPC WE Reference Code Lists and X12 Registry Code Lists X12 Registry X12 assists several organizati the A complete Ii xternal to or Medicare and Me CMS The National Uniform Claim C committees that meet during standing Code Lists for ings Purchase Health Care Code Lists esed ed files email change alert subscription or printed lists It s the simple things that matter most Get the Medicare prescription drug coverage you need the benefits you want and Property amp Casualty Code Lists the savings you Several EDI Related Property amp Casualty Code List deserve LEARN MORE Providers can use the WPC lists to look up HIPAA compliant codes that a
85. mental health MN Do not use the AUC Appeals Cover Sheet Use the AUC Uniform Cover Sheet only for electronic claims that require an attachment Do not use the AUC Uniform Cover Sheet Janine without an attachment control number ACN or to submit authorization requests that Alcohol and drug abuse require attachments Child and Teen Checkups Create a unique ACN ACN must be unique to each claim and not patient account number unless patient has new account number each Child care providers visit Child support Enter the appropriate ACN including spaces hyphens on each Children s mental health attachment page each type of attachment must have its own completed Disability services Attachment Control Number PWK field select the qualifier in the type Employment services field manual Batch Enter the ACN s in Loop 2300 PWKO6 enter the County redesign Cover Sheet the Cover Sheet and your electronic claim Sedaan Interactive Enter the ACN s in the Claim Information tab Food support outreach attachment type in Loop 2300 PWK01 enter the method by which ind thi hment information in PWKI folle a Chee Shea lA o Y Submit the claim electronically via MN ITS Interactive or Batch Managed care Fax the Cover Sheet and attachment s to MHCP at 651 431 7706 Sen S Providers must end the attachment hv end nf next husiness dav after suhmittinn the electronic To submit claims with attachments this Web page provides you with links to M
86. mount meson Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original SLE Related Links MNATS User Guides zRequired Field Situationat if applicable complete all fields within a section Claim Information Provider Website Situational Claim Information z Electronic Claim Attachme MHCP Payment Claim Calendars Fee Schedule Provider Identifier Provider Training MPI Add NPUUMPI dd MHCP Provider Profile hi n ERES Address Taxonomy Information Change Forms 1234 MAIN STREET ANYTOWN 4DOE Des MN 55155 Pay To Provider ProviderEnrollment Referring Provider NDC Search ServiceFacility Location Washington Publishing Company Assistant Surgeon Provider Questions or Comments ContactUs The rendering providers name address and any taxonomy information that is on file with MHCP will now display Select the Radio Button next to the providers name to save the entry at the claim level The other providers Pay To Referring Service Facility Location or Assistant Surgeon may be required depending on the service being preformed There are subsections for each type of other provider with their own accordion panel Select Continue to move on to the COB Screen Coordination of Benefits COB Other Payer Information Dental 837D COB Billing Provider MHCP PROVIDER Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Required Field 1 Other Payer Total Claim Charge Amount
87. n Publishin Washington Publishing Company Questions or Comments Cancel Contact Once you have saved your second lines COB depending on your service line you may need to add additional information to that specific line in either the Situational Services or Other Payers accordion panels Additional Action Buttons Dental 837D Services Billing Provider MHCP PROVIDER Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Required Field Line 2 Services Other Payer COB Line Payments Adjustments Other Payer Primary Identifier Name 01 123456 Health Insurance Co Situational Services Other Providers Cancel amp Print Page Total Claim Charge Amount 115 00 Type of Claim Original Situational if applicable complete all fields within a section Line Paid Amount Total Adj Amt 10 00 10 00 Copy Delete Application Progress WBilling Provider Edit W Subscriber Edit Claim Information Edit COB Edit 4 Claim Services Related Links MN ITS User Guides Provider Website Electronic Claim Attachments MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms Individual Practitioner Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Contact Us Below the accordion panels are several action buttons The provider can choose to Add a new line Copy
88. n saved Application Progress 9 PuntPage Willing Provider Edit Imi Subscriber E dit i Claim Information Edi Billing Provider MHCP PROVIDER Total Claim Charge Amount Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original Required Field 1 P Primary 123456 Health in Other Payer OtherPa Name yer OtherPayer PrimaryID Health Insurance Co Claim Filing 1 Indicator e Commercial Insurance Co Other Payer Subscriber Payer Responsibility Insurec ID Relationshir P Primary code DOOOOOOCX 18 Self Claim Level Adjustments Adj Reason Code Claim Adjustment Group Code Adj Amount Adj Quantity Select One Claim Adjustment Group Code Adj Reason cod AdjAmount No records found Other Payer Amounts PayerPaid Amount Non Covered Charge Amount Other Insurance Information Benefits Assignment Yes No NotApplicable Release ofinformation Yes Informed Consent Delete Cancel In our example there is only one payer so we will sele to the Services screen luationat if applicable complete all fields within a section 7 COB Claim Services Related Links MNATS User Guides Provider Website MHCP Paye Calendars ich Provider Trainina MHCP Provider Profile Change Forms Individual Practitioner Organization Provider Enrollment NOC Search Washington Publishing Company Questions or Comments ContactUs ct Cont
89. n to save the new entry Entries made at the service line level will override what was entered at the claim level To add one of the other provider types Service Facility Location Supervising Provider or Assistant surgeon to your service line select the appropriate closed accordion panel enter the NPI or UMPI for the provider and again select the Add button and then select the Radio Button to save the entry Action Buttons Add Copy or Delete Dental 837D Services Application Progress Billing Provider Edit w Subscriber Edit Billing Provider MHCP PROVIDER Total Claim Charge Amount 95 00 ill Claim Information Edit w COB Edit Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original 7 Claim Services Required Field Situational if applicable complete all fields within a section Provider Identifier NPI UMPI Add Name Address 1234 MAIN STREET A ROE DDS ANYTOWN MN 55155 On the new MN ITS screens there will be two ways to create a new service line 1 Selecting Copy creates a new service line that automatically duplicates the same information as the current line you just completed Remember if you entered other payer situational services or an other provider on the line you are copying you will need to re verify those entries are correct for this new line you will be submitting 2 Selecting ADD will display an entirely new service line that will display with blank fields ready for you to enter
90. nal fields within the same subsection Subsections are grouped in blue outlined boxes such as seen Attachments or Accident Information Refer to the MN ITS user manual user guides for instructions regarding specific services 61 Situational Claim Information MHCP Authorization Number Dental 837D Claim Information Application Progress Print Page Billing Provider Edit i Subscriber Edit 7 Claim Information CoB Claim Services Original Billing Provider MHCP PROVIDER Total Claim Charge Amount Subscriber 01044759 FIFTYTEN M TESRECIPO2 Type of Claim Situational if applicable co Related Links n Attachments Prior n Number Claim Note Entry Text Provider Training MHCP Provider Profile Change Forms Attachments Control Number Control Number Type ID Attachment Type Description No records found Accident Information Questions or Comments Related Causes Contact Us Other Providers Claim Level Cancel If the service you are billing requires an authorization use the prior authorization number field to enter the assigned 11 digit MHCP authorization number Situational Claim Information Claim Note FQHC RHC Dental 837D Claim Information Application Progress Billing Provider Edit Subscriber Edit V Claim Information c f MHCP PROVIDER Total Claim Charge Amount 01044759 FIFTYTEN M TESRECIPO2 Claim Services For most providers a claim note is not needed
91. ncel Continue o Individual Practitioner O Organization Provider Enrollmen Search A Washington Publishing Company Questions or Comments Contact Us 2011 Minnesota Department of Human Services Online Updated 11 19 2012 10 43 19 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology Next on the right navigation menu NDC Search is intended for use by pharmacies and physicians who administer or prescribe drugs NDC Search Skip to Main content Subnavigation Quicklinks north star National Drug Code Search NDC Code Date Of Service a Submit Accessibility Terms Policy Contact DHS Top of Page By entering the National Drug Code assigned to the medication and the date of service pharmacies and physicians can verify MHCP coverage information for that specific medication 37 Washington Publishing Company WPC Dental 837D Billing Provider Application Progress amp Print Page V Billing Provider y Subscriber amp Ifthe Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Claim Information COB Billing Provider Information Claim Services Organization MHCP PROVIDER Taxonomy Related Links MN ITS User Guides Address1 1234 MAIN STREET Provider Wi Address2 rovider Website Electronic Claim Attachments City ANYTOWN State MN Zip 55155
92. ncounter has been accepted into the adjudication system Start 01 01 1995 Acknowledgement Returned as unprocessable claim The claim encounter has been rejected and has not been entered into the adjudication system Start 01 01 1995 In the Claim Information our claim status category code is A1 which means that the claim has been acknowledged but not accepted for adjudication Reference X12 Registry Code Lists AS several organizstions in the maintenance and family andards The sre maintained by care and Medicaid CMS The National Uniform Claim and committees that meet during standing X12 meetin Health Care Code Lists gt Clain Property amp Casualty Code Lists everal EDI Related Property amp Casualty Code WPC HIPAA Compliant Code Lists CINES LIEN C CEN C X12 Registry email change aler subscription or printed lists 12N s Task G Technical Report Task ns a collect 100 Free Medical Billing SOFTWARE COMPREHENSIVE amp COMPLETE Begin Billing IMMEDIATELY Back on the WPC code list we now select the claim status codes link WPC Claim Status Codes CTCEN Ss CN Co C73 Reference Reference Code Lists Health Care Health Care Claim Status Codes ASC X12 External Code Source 508 LAST UPDATED 7 1 2013 Health Care Claim Status Codes convey the status of an entire claim or a specific service line 5 Q For the health of all Filter Codes by Status Show Al Star
93. ngton Publi mpan Bill Type D Service Period 08 01 2013 Auestions or Status Info Effective Date 08 17 2013 08 01 2013 Contact Us Total Claim Charge Amount S 115 00 parece Control 91322900400000001 Pharmacy Prescription Number Claim Payment Amount 33 24 Claim Status Category Claim Status Adjudication Date 08 17 2013 P1 3 Remittance Date Trace Number 000000000 The screen now displays a message at the top stating Submission Response This claim has been submitted for processing The payer claim number PCN is displayed as a control in orange below the MHCP contact information 122 Submit Response Claim Information Washington Publishing C mpany Bill Type D Senice Period 08 01 2013 Questions or Status Info Effective Date 08 17 2013 08 01 2013 Contact Us Total Claim Charge Amount 115 00 alec Control 91322900400000001 Pharmacy Prescription Number Claim Payment Amount 33 24 Claim Status Category Claim Status Adjudication Date 08 17 2013 P1 3 Remittance Date Trace Number 000000000 Service Line Information Line Number 01 Procedure D0140 Modifiers s Charge 95 00 Units 1 00 Service Dates 08 01 2013 Claim Status Category Claim Status 08 01 2013 Payment 25 31 Revenue code Status Information Effective Date 08 17 2013 A1 20 Line Number 02 Procedure D0220 Modifiers s Charge 20 00 Units 1 00 Replace Void Notice the claim payment amount now displays along side t
94. ogress 7 Billing Provider Subscriber Claim Information COB Claim Services Related Links MN ITS User Guides Provider Wi il Electroni laim Attachments MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms O Individual Practitioner o Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Contact Us 2011 Minnesota Department of Human Services Online Updated 11 19 2012 10 43 19 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology The Provider Enrollment page provides additional information about adding or changing your MHCP provider profile information or enrollment status 35 NDC Search Dental 837D Billing Provider Application Progress Print Page 7 Billing Provider Subscriber amp If the Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Claim Information COB Billing Provider Information Clan Sercoe Organization MHCP PROVIDER Taxonomy Related Links MN IT Address 1234 MAIN STREET S User Guides Provider Website Address2 C City ANYTOWN State MN Zip 55155 s Electronic Clam Attachment MHCP Payment Claim Telephone 651 431 2700 Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms Ca
95. ormation on Industry Initiatives that impact providers such as provider incentives for those dentists that meet the electronic health record requirements By selecting Manual you will be directed to the MHCP Manual where providers can access our dental policy and dental authorization information From the center section providers can also access provider specific information by selecting the drop down arrow selecting Dental Providers and then select the go button to be directed to the Dental Providers provider specific Webpage Electronic Claim Attachments Dental 837D Billing Provider Application Progress amp Print Page VI Billing Provider Subscriber If the Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Claim Information Billing Provider Information coe Services Organization MHCP PROVIDER Taxonomy Related Links MN ITS User Guides Address1 1234 MAIN STREET Provider Website Electronic Claim Attachments Telephone 651 431 2700 MHCE RIECE Claim Address2 City ANYTOWN State MN Zip 55155 Fee Schedule Provider Training MHCP Provider Profile Change Forms Cancel Continue o Individual Practitioner Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Contact Us 2011 Minnesota Department of Human Services Online Updated 11 19 2012 10 43 19 Accessibility
96. ovider MHCP PROVIDER Total Claim Charge Amount C uen Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original Claim Services Required Field Situationat if applicable complete all fields within a section Related Bae MNATS User Guides Claim Information P Provider Websit ClaimFrequencyCode Original O Replacement O Void Payer Claim Control Number Place of Service 11 OFFICE M 11 OFFICE ia Patient Control Nu 1 2 HOME 13 ASSISTED LIVING FACILITY AssignmentPlan 1 4 GROUP HOME ed O NotAssigned 15 MOBILE UNIT Provider Training Benefits Assignm 1 6 TEMPORARY LODGING P No NotApplicable 17 WALK IN RETAIL HEALTH CLINIC 4 Release of Inform 20 URGENT CARE D Informed Consent TR Provider Profile 214NPATIENT HOSPITAL nge Provider Indicator 22 OUTPATIENT HOSPITAL lire onFile Signature noton File Enter Diagnosis 23 EMERGENCY ROOM HOSPITAL c Individual r Diagnosis 152 AMBULATORY SURGICAL CENTER Practitioner 25 BIRTHING CENTER Organization Diagnosis Code 5 MILITARY TREAMENT FACILITY 31 SKILLED NURSING FACILITY Provider Enroliment Se 32 NURSING FACILITY 33 CUSTODICAL CARE FACILITY 2 34 HOSPICE NDC Search 1 41 AMBULANCE LAND 42 AMBULANCE AIRE OR WATER Situational Claim I 49HNDEPENDENT CLINIC 5O FEDERALLY QUALIFIED HLTH CENT A Other Providers d 9 INPATIENT PSYCHOLOGY FACILITY Questions or Comments 52 PSYCHIATRIC FACILITY PART HOSP ContactUs 53 COMMUNITY MENTAL HEALTH CENTER S44NTER CAR
97. processing Minnesota Department of Human Services 08 17 2013 10 28 41 1674742 MHCP Provider Call Center 651 432 2700 or 1 800 366 5411 rvice Period 08 01 2013 08 Receiver NPVUMPI 1234567890 Name MHCP PROVIDER Provider NPI UMPI 1234567890 Name MHCP PROVIDER Subscriber ID Number 01044759 Name FIFTYTEN TESTRECIP02 Patient Control Number TESTRECIP02 Claim Information Related Links MN ITS User Guides Provider Website Electronic Claim Attachments MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms o Individual Practitioner o Organization Provider Enrollment NDC Search Washington Publishing Company Questi Bill Type D Service Period 08 01 2013 oen dod Status Info Effective Date 01 01 0001 08 01 2013 Contact Us Total Claim Charge Amount 115 00 Payer Claim Control Number Pharmacy Prescription Number Claim Payment Amount 0 00 Claim Status Category Claim Status Adjudication Date A1 0 Remittance Date Trace Number 000000000 At the top of the page a message will state Validate Response Only This claim has not been submitted for processing Displayed is the Receiver and Providers NPI and name and the Subscriber ID name and patient control number In the Claim Information section providers should review the Claim Status Category and Claim Status codes to determine if any errors exist on the claim The HIPAA compl
98. r defines the process for using the Provider Call Center and the options available Action Buttons Cancel Dental 837D Billing Provider Application Progress Print Page V Billing Provider Subscriber If the Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Claim Information Billing Provider Information coe Sanices Organization MHCP PROVIDER aero Related Links MN IT e Address1 1234 MAIN STREET MN ITS User Guides Address2 Provider Website r Electronic Claim Attachments EI Telephone 651 431 2700 MBCE Payment Claim City ANYTOWN State MN Zip 55155 Fee Schedule Provider Training MHCP Provider Profile Change Forms Cancel Continue o Individual Practitioner Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Contact Us 2011 Minnesota Department of Human Services Online Updated 11 19 2012 10 43 19 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology On the Billing Provider screen there are several action buttons below the billing provider fields Some may be protected or hidden as this is the first screen and the claim is not complete On this screen the options are to cancel the claim or continue 42 Action Buttons Continue Dental 837D Billing Provider Application Progress
99. ract Code Maintenance MN ITS Your access to MN ITS functions and applications on the left menu has been tailored based on the services you provide Your MN ITS Administrator may further restrict your views access Learn which functions and applications apply to your provider type and contact your MN ITS Administrator with questions These functions listed below represent an exhaustive list and may not appear for each user Eligibility Request 270 Look up subscriber eligibiity and coverage and receive an Eligb ty Response 271 Verify ebgiblity for up to 50 recipients at a time by using the Multiple Eligibilty Inquiry function Authorization Request 278 Create and submit authorzation requests Service Agreement Request 278 Create and submit service agreement requests Submit Transactions Submit and view history for X12 production batch X12 test batch and miscellaneous e affiliation data supplemental payments etc transactions Submit Interactive Claims 837 Submit claims directly to MHCP Request Claim Status 276 Check the status of a submitted claim Batch Submitters Refer to X 0 north Star Related Pages Troubleshooting Guide MHCP Payment amp Claim Cut off Calendars MHCPF l X12 NCPDP Submitters Provider Updates Provider Website Sign Up for Email Li Questions or Comments t Provider Relation Next from the left navigation under MN ITS select Submit DDE Claims
100. re displayed on your claim responses and your remittance advices 39 Questions or Comments Contact Us Dental 837D Billing Provider Application Progress amp Print Page 7 Billing Provider a Subscriber amp If the Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Claim Information COB Billing Provider Information Clai Serica Organization MHCP PROVIDER Taxonomy Related Links MNHT Address1 1234 MAIN STREET r Gui Provider Wi il Address2 2 nic Claim Attachments City ANYTOWN State MN Zip 55155 Electronic Claim Attachments Telephone 651 431 2700 HCP Payment Clam Fee Schedule Provider Training MHCP Provider Profile Change Forms Cancel Continue o Individual Practitioner Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Contact Us 2011 Minnesota Department of Human Services Online Updated 11 19 2012 10 43 19 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology Our final link on the right navigation menu can be used to locate information on how to reach MHCP if you have additional Questions or Comments Select Contact Us 40 MHCP Contact Information ntent Subnavigation Quicklini h monie Services E ewo Search Eorms eDocs County and Tribal Workers AzTopi
101. rofile change form and faxto Provider Enrollment Billing Provider Information Organization MHCP PROVIDER Taxonomy Address 1234 MAIN STREET Address2 City ANYTOWN State MN Zip 55155 Telephone 651 431 2700 Select Location Location Address Provider Type Taxonomy Information 1234 MAIN STREET STE 110 DENTAL 125K00000X Advanced Practice ANYTOWN MN 55155 HYGIENIST Dental Therapist SMILE BRIGHT 1234 MAIN STREET STE 100 DENTIST a GENERAL DENTISTRY ANYTOWN MN 55155 SMILE BRIGHT 1234 MAIN STREET STE 120 PHYSICIAN 1223S0112X Oral and Oo ORAL ss pers iine ANYTOWN MN 55155 Maxillofacial Surgery Ul Y SMILE BRIGHT ADT amp DTS 1223G0001X General Practice Application Progress 4 Billing Provider Subscriber Claim Information CoB Claim Services Related Links MNAITS User Guides Provider Website Electronic Claim Attachments MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms c Individual Practitioner Organization Provider Enroliment NOC Search Washington Publishing pan Providers who have one NPI for multiple locations are known as consolidated providers Each location that is associated with the NPI used to login to MN ITS will display with each locations name address provider type and any associated Taxonomy information that provider has on file with MHCP in a table format Not all consolidated providers need a taxonomy code
102. roviders website FOR THE WEBINAR ONLY We will take a brief 10 minute break before we begin our question and answer session Please remember to submit any questions to the Leaders and Assistants group using the webinar chat feature Thank you for attending the 837D Dental webinar for the layout and functionality of the new MN ITS Screens 138
103. s manual entry and submission directly into MN ITS to Request Claim Status Verify eligibility Bubmit DDE Claims Request authorization Check claim status Copy replace void a claim It allows direct data entry and submission of 837D 8371 and 837P claim transactions Additional feature details and step by step user guides are available by selecting the link below Eligibility Verification Authorization Request Request Claim Statu Copy Replace and Void a Claim Submit E Claims Refer to MN ITS and Electronic Billing in Billing Policy of the MHCP Provider Manual for additional details of these features Providers who use HIPAA compliant billing software or are a billing organization may submit transactions through MN ITS Batch Return to MN ITS Homepage The Direct Data Requests Web page contains links to the following user guides Verifying eligibility Submitting requests for authorization Requesting claim status Using the Copy replace void claim features Submitting DDE Claims From the left navigation menu select Submit DDE Claims 22 MN ITS User Manual gt MN ITS User Manual gt Direct Data Entry DDE gt Submit DDE Claims Table of Contents MN ITS Administration MN ITS Mailbox Direct Data Entry DDE Eligibility Verification Authorization Request Request Claim Status Submit DDE Claims 837P Professional 8371 Institutional 837D Dental Other Applicat
104. se Technology Application Progress 7 Billing Provider Subscriber Claim Information COB Claim Services Related Links MNHTS User Guides Provider Website Electronic Claim Attachments MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms o Individual Practitioner Organization Provider Enrollment NDC Search Washington Publishin Company Questions or Comments Contact Us Updated 11 19 2012 10 43 19 Accessibility Terms Policy Contact DHS Top of Page The Application Progress feature to the upper right is new It displays which screens have been completed and will help you navigate from screen to screen We ll discuss this more as we navigate through the claim screens Additional links on the right navigation menu under Related Links provides you with additional information you may need while entering a claim 17 Related Links MN ITS User Guides Dental 837D Billing Provider 9 Print Page Z If the Billing Provider information is inaccurate complete the appropriate profile change form and fax to Provider Enrollment Billing Provider Information Organization MHCP PROVIDER Taxonomy Address1 1234 MAIN STREET Address2 City ANYTOWN State MN Zip 55155 Telephone 651 431 2700 2011 Minnesota Department of Human Services Online Updated 11 19 2012 10 43 19 Accessibility Terms P Application Progress 7 Billin
105. signed a Provider Training Benefits Assignment Yes O No O Not Applicable MHCP Provider Profile Change Forms Release of Information Yes Informed Consent o Provider Indicator Signature on File Signature not on File individual Enter Diagnosis Code Practitioner Organization Diagnosis Code Provider Enrollment Sequence Diagnosis Code NDC Search Delete Washington Publishing Company Questions or Comments Situational Claim Information Contact Us Other Providers Claim Level Make sure all of the required fields have been completed before moving to the next accordion panel or screen They are Place of service Patient control number Assignments Plan participation Benefits assignment Release of information Provider indicator and the Diagnosis code Claim Information Accordion Collapsed Screens Dental 837D Claim Information Application Progress I PrintPage illing Provider Edit Subscriber Edit v i Int iti Billing Provider MHCP PROVIDER Total Claim Charge Amount CR reor aon Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original Clan senicas Required Field Situationat if applicable complete all fields within a section AVIA MNAITS User Guides Claim information Provider Websit Claim Frequency Code Original Replacement Void Payer Claim Control Number Electronic Claim Attachmer Place of Service 11 OFFICE v
106. t 01 01 1995 OR 90 DAY 4 For more detailed information see remittance advice HEALTH Start 01 01 1995 COVERAGE 2 More detailed information in letter Start 01 01 1995 3 Claim has been adjudicated and is awaiting payment cycle Start 01 01 1995 6 Balance due from the subscriber Start 01 01 1995 The claim status code 0 tells us the because the claim is in a validate status the claims system cannot provide further status electronically Now we will close the WPC code list and return to the validate response to review the service line status codes Validate Response cont Claim Information gt Washington Publishing Company r Questions or Bill Type D Service Period 08 01 2013 Comments Status Info Effective Date 01 01 0001 08 01 2013 Contact Us Total Claim Charge Amount 115 00 Payer Claim Control Number Pharmacy Prescription Number Claim Payment Amount 0 00 Claim Status Category Claim Status Adjudication Date A1 0 Remittance Date Trace Number 000000000 Service Line Information Line Number 01 Procedure D0140 Modifiers s Charge 95 00 Units 1 0 Service Dates 08 01 2013 Claim Status Category Claim Status 08 01 2013 ad 20 Payment S 0 00 Revenue code Status Information Effective Date 01 01 0001 Line Number 02 Procedure D0220 Modifiers s Charge 20 00 Units 1 00 Each Service line will display in accordion panel format with their own status codes Notice that line 2
107. t has been completed Once completed an Edit link will display after the screen name such as seen next to Billing Provider By selecting a edit link you can return to a completed screen to review or make any necessary corrections 45 Subscriber Required Fields amp Action Buttons IDental 837D Subscriber Application Progress Billing Provider Edit v Subscriber Claim Information N COB Billing Provider MHCP PROVIDER Claim Services Required fields Subscriber Related Links MNHTS User Guides Subscriber ID Birth Date Provider Website Electronic Claim Attachments MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms o Individual Practitioner o Organization Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Contact Us 2011 Minnesota Department of Human Services Online Updated 11 19 2012 13 22 17 Accessibility Terms Policy Contact DHS Top of Page North Star is led by the Office of Enterprise Technology Required fields on the New MN ITS Screens are now indicated with single red asterisks in the Subscriber section Throughout the new MN ITS screens single red asterisks indicate fields that must be completed before continuing to the next screen Once past the Provider Screen the Back action button displays and when selected will return you to the provider screen 46 Dent
108. tart 01 01 1995 A5 Acknowledgement Split Claim The claim encounter has been split upon acceptance into the adjudication system Start 02 28 2002 AG Acknowledgement Rejected for Missing Information The claim encounter is missing the information specified in the Status details and has been rejected Pending PO Pending Adjudication Details This is a generic message about a pended claim A pended claim is one for which no remittance advice has been issued or only part of the claim has been paid Start 01 01 1995 Start 01 01 1995 P1 indicates the claim is in a pending or in process For the health of all NEED 30 60 OR 90 DAY HEALTH COVERAGE Reference X12 Registry Code Lists AS several organizstions in the maintenance and family andards The sre maintained by care and Medicaid CMS The National Uniform Claim and committees that meet during standing X12 meetin Health Care Code Lists gt Clain Property amp Casualty Code Lists everal EDI Related Property amp Casualty Code WPC HIPAA Compliant Code Lists CINES LIEN C CEN C X12 Registry email change aler subscription or printed lists 12N s Task G Technical Report Task ns a collect 100 Free Medical Billing SOFTWARE COMPREHENSIVE amp COMPLETE Begin Billing IMMEDIATELY Back on the WPC code list we now select the claim status codes link WPC Claim Status Codes ns reme J nep C7 UTE Reference Cod
109. tate of MN e http sfwmw dhs state mn uslnsnjidcplg IdcService GET_DYNAMIC_CONVERSIONGRevisionSelectionMethodmLatestReleasedidDocNamemdhs16_ 170653 Fie Edt View Favorites Tools Help WO f MNAITS Help 8370 6371 amp 837P Provider Aree B MN ITS Help 837D 8371 amp 837P Billing Provider Information The table below describes the individual fields on the Provider Information screens MN ITS auto populates the information on this screen using the current MHCP enrollment data from the login NPU UMPI The Field Name column identifies X12 loops and elements only for fields that display in the MN ITS screens Refer to the X12 HIPAA Companion Guides available through the WPC X12 Registry for additional instruction when submitting batch Claims Select MN ITS User Guides to obtain additional instruction for submitting claims for specific services using MN ITS Direct Data Entry ODE Field Name Valid Values Character Length Field Description X12 Loop amp element Organization 35 Billing Provider or Organization Name Loop 2010AA NM103 alphanumeric last or organization The Biling Provider may be an individual only when the NM104 first health care provider performing senvces is an independent unincorporated entity In these cases the Billing Provider is the individual whose Social Security number is used for 1099 purposes Taxonomy 10 The feld ioniy slays information when a Health care Loop 2000A PRV03 alphanumeric
110. te MHCP Provider Profile Encounter in preparation for a denture Change Forms Attachments Individual Control Number Practitioner Control Number Type ID Attachment Type Description Provider Enrollment No records found NDC Search Accident Information Code Questions or Comments Related Causes Other Providers Claim Level Back Cancel Continue The saved claim note will display in the claim note table Situational Claim Information Attachments Dental 837D Claim Information jer MHCP PROVIDER 01044759 FIFTYTEN M TESRECIPO2 The attachments subsection is used to enter your claims attachment control number and the claims attachment type when supporting documentation must be provided for MHCP to process the claim Situational Claim Information Control Number amp Type Dental 837D Claim Information lling Provider MHCP PROVIDER 01044759 FIFTYTEN M TESRECIPO2 Type OZ SUPPORTDATAFORCLAIMM Attachment Type Description The attachment control number must be unique to this individual claim and is created by the Provider For dental claims use Type OZ which equals Support data for claim Then select the Add action button to save the entry Situational Claim Information Attachment Information Added Dental 837D Claim Information Billing Provider MHCP PROVIDER Subscriber 01044759 FIFTYTEN M TESRECIPO2 Required Field Claim Information Prior Authorizat
111. the existing line to add an additional line Delete the line or select Save View Line s to display the service line s table In our example we will select Save View Line s Services Line Table Dental 837D Services Billing Provider MHCP PROVIDER Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Required Field Line From 08 01 2013 08 01 2013 Cancel The Total Claim Charge Amount displays the total of both lines in the Service amp Print Page Total Claim Charge Amount 115 00 Type of Claim Original Situational if applicable complete all fields within a section Charges 95 00 20 00 Submit POS 11 11 Validate Application Progress Billing Provider Edit Subscriber Edit Claim Information Edit w COB Edit 7 Claim Services Related Links MNHTS User Guides Provider Website Electronic Claim Attachments MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms o Individual Practitioner Organization Provider Enrollment NI rch Washington Publishin Company Questions or Comments Line Table along with a recap of some of the information that was entered on each line 108 Services Line Table Edit Action Button IDental 837D Services Billing Provider MHCP PROVIDER Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Required Field Line From 08 01 2013 08 01 2013 C
112. the services you provide Your MN ITS Administrator may further restrict your user views access Learn which functions and applications apply to your provider type and contact your MN ITS Administrator with any questions Find Links here to Provider Updates for the services you deliver and Provider News for all providers Use Quick Search to find older updates or check Provider Updates Contact our Provider Call Center at 651 431 2700 or 1 800 366 5411 to request that we place a Remittance Advice file older than 1 year in your Archive folder Quick Search Start Date File T 09 24 2012 dide Links End Date 10 24 2012 e Search There were no records found that match your search Accessibility Terms Policy Contact DHS Top of Page Once logged in MN ITS will open to the Mailbox Home page that may contain provider news messages and provider updates From the left navigation menu select MN ITS the Minnesota Department of Human Services Submit DDE Claims 837 Skip to Main content Subnavigation Quicklinks tiers Home ABiller 1234567890 Logout Mailbox MNATS Eligibility Request 270 Authorization Request 278 User Administration User Guides CCDS Reporting System CCDTF Rates CMH Outcome Measures Health Care Homes Health Information Request Last Check MFPP Forms Ombudsman Data Pay for Performance Provider Lists Individual PCAs Provider Lists RxPrioe Compare Update Taxonomy Cont
113. tion we are in is indicated by the orange title Services and the other sections are collapsed in blue Most fields remain the same so in our example we will be pointing out the newer fields before we complete a service line example Procedure code modifiers display as a table that allows providers to enter up to 4 different modifiers Currently modifiers are not required for the MHCP dental claim transaction 85 Services Diagnosis Pointer s Application Progress Billing Provider Edit m Subscriber Edit 3 I Claim Information Edit ider MHCP PROVIDER otal C rge Amount qeu 7 01044759 FIFTYTEN M TESRECIPO2 ype of Claim riginal Ciim Serices 11 OFFICE 1st 2nd Modifier Modifier select one Y select one select one M The diagnosis pointers appear in a table that displays up to 4 different ICD9 diagnosis codes The first diagnosis field is auto populated from the claims information screen with V72 2 which is the defaulted diagnosis If additional diagnosis codes were entered at the claim level the defaulted diagnosis will appear in each of the fields You can change the defaulted diagnosis in any position by selecting the drop down menu to display the list of available codes Select the most appropriate diagnosis code for the service line you are entering 86 Services Required Fields Line 1 Completed Application Progress Print Pa Billing Provi Billing Provider MHCP PROVIDER 0104
114. tted by entering their NPI or UMPI New to the Claims Request Status feature in MN ITS is the capability to Copy replace or void all dental claims This includes claims submitted using MN ITS Direct Data Entry or Batch claims sent electronically by a billing organization or clearinghouse that are uploaded through MN ITS Submit Transactions secure FTP file Up to three years of claims history can be retrieved 133 Quick Search Skip to Main content Subnavigation Quicklinks CUN ITS Home Ki Minnesota Department of Human Services north Star Abiller 1234567890 Logout Health Care Claim Status Request Related Links MNHTS User Guides Provider Website a F CK Search Electronic Claim Attachments Subscriber ID Service Date From Service Date To MHCP Payment Claim I Pay To Provider 7 Calendars NPVUMPI Feo Schedule Detail Search Provider Training MHCP Provider Profile Payer Claim Control Number Change Forms Pharmacy Prescription Number Individual Practitioner o Organization Submit Provider Enrollment NDC Search Washington Publishin Company Questions or Comments e Contact Us The New Quick Search section has two fields that are always required Subscriber ID and Service Date From The service date from is the first date of service on the claim or the first date within a range of dates you are requesting The Service Date To can be left blank and wil
115. uthorization request for consolidated NPI The Table of Contents lists in the center section all of the user guides that are available The user guides are grouped under the different heading options which also appear in the left navigation menu Next from the left navigation menu select MN ITS Administration 20 MN ITS User Manual Skip to Main content Subnavigation amp the Minnesota Department of Human Services MN ITS User Manual EM MN ITS User Manual Advanced Search Table of Conte MN ITS User Manual Administration rati MN ITS Administration Submit DDE Claims Overview This information is intended for use by each MHCP enrolled organization s chosen MN ITS Primary Administrator PA after the administrator has completed MN ITS Registration The user guides included on this page provide step by step instructions for basic MN ITS functions related to Initial registration Log in Passwords User access MN ITS Mailbox Changing the primary administrator MN ITS User Levels in Your Organization Level Ill Following completion of MN ITS registration the PA has the ability to create change or disable users reset passwords and assign roles for Level and Level Il users Certain administrators have the capability to test X12 batch transactions Only MHCP can reset the PA s password through submission of a PA Change Request form Refer to the user guide Change Primary Administrator L
116. vi Application Progress Billing Provider MINNESOTA DEPARTMENT OF HUMAN SERV riber 01044759 FIFTYTEN R TESTRECIPO2 COB Line Ad ci Adj Select Verify all of the other payers paid amounts and adjustments for this service line have been entered If all entries have been made and select the Save action button to display the COB table that calculates the total amounts that were entered for line two 104 Other Payer Summary Table COB Line Payments Adjustments Dental 837D Services Application Progress Print Page Billing Provider Edit wi Subscriber Edit Billing Provider MHCP PROVIDER Total Claim Charge Amount 115 00 Claim Information Edit COB Edit Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original 7 Claim Services Required Field Situational if applicable complete all fields within a section Related Links MN ITS User Guides Line 2 Provider Website ervices Electronic Claim Attachments MHCP Payment Claim COB Line Payments Adjustments Calendars Other Payer Primary Identifier Name ine Paid Amount Total Adj Amt Fee Schedule 01 123456 Health Insurance Co 10 00 10 00 Provider Training MHCP Provider Profile Change Forms Individual Practitioner o Organization her Providers Provider Enrollment NDC Search Save View Line s Copy Delete Washington Publishin Company ADD Questions or Comments Contact Us Asummary of the Other Pay
117. vider MHCP PROVIDER Required fields Subscriber Subscriber ID 01044759 Birth Date 01 01 1993 First Name FIFTYTEN Middle Initial R Last Name TESTRECIPO2 Gender F Delete Cancel Application Progress Billing Provider Edit V Subscriber Claim Information 1coB E Claim Services Related Links MN ITS User Guides Provider Websit Electronic Claim Attachments MHCP Payment Claim Calendars Fee Schedule Provider Training MHCP Provider Profile Change Forms Individual Practitioner o Organizati Provider Enrollment NDC Search Washington Publishing Company Questions or Comments Contact Us 2011 Minnesota Department of Human Services Online North Star is led by the Office of Enterprise Technology Updated 11 19 2012 13 50 12 Accessibility Terms Policy Contact DHS Top of Page If the subscriber displayed is correct for your claim select the continue action button to move on to the next screen Claim Information 51 Claim Information Screen Dental 837D Claim Information Application Progress Billing Provider Edit 8i Subscriber Edit 7 Claim information Billing Provider MHCP PROVIDER Total Claim Charge Amount a ome Subscriber 01044759 FIFTYTEN R TESTRECIPO2 Type of Claim Original Clan senicas Required Field Situationat if applicable complete all fields within a section AVIA MNHTS User Guides Provider Website Cla
118. xt in the right navigation menu under Related Links the Provider Website link takes us to the MHCP Enrolled Provider Website MHCP Provider Website the Minnesota Department of Human Services DHSHome Page Forms eDocs Countyand Tribal Workers AZIopks Partners amp Providers Children Tee MHCP Enrolled Providers Home MHCP provider toolbox Biling resources Communication ota Health Care Programs MHCP provider home page Enrollment Industry Initiatives Please select from the menu below and click GO to access our online materials Manual Prescription drug information SELECT YOUR PROVIDER TYPE v 89 If your provider type is not listed above Check eligibility s C m claim stat If you are not an MHCP provider but wish to enr Contact the Provide e mail us with any questions or comments about these pages AMA Disclaimer Notice If you have arrived on this page as a result of a search engine or other external link be advised that some of these files contain material that is copyrighted by the American Medical Association You are forbidden to download the materials unless you read agree to and abide by the provision of the copyright statement Read the taternent now you will be directed back here after accepting the copyright statement From the home page you can access MHCP Billing resources Communications such as our Provider News Messages and Provider Updates It also provides inf

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